Penile squamous cell carcinoma (PSCC) is characterised by stepwise lymphatic dissemination. Skip metastases (SkMs) are rare metastases in the corpus cavernosum or spongiosum without continuity to the primary tumour or its resection site.
To assess the distinct pattern of spread in SkM+ patients and the effect of SkM on prognosis.
We conducted a retrospective analysis of patients with SkM+ PSCC at ten high-volume international referral centres between January 2006 and May 2022.
We evaluated histopathological data, primary lymph node (LN) staging, and metastatic spread. We included a cohort of patients matched for pT stage, LN status, and grade who did not have SkM (SkM-) to compare the SkM prognosis and predictive value for cancer-specific mortality (CSM).
Among the 63 SkM+ patients who met our inclusion criteria, the SkM diagnosis was synchronous in 54.0% and metastases were mostly located in the corpus cavernosum. SkM was symptomatic in 14% of cases, was detected on imaging in 32%, and was found incidentally on pathological examination in 27%. Fifty-one patients (81%) presented with positive LNs and 28 (44%) developed distant metastases. Seven patients (11%) presented with or developed distant metastasis without displaying any LN involvement. The 2-yr cancer-specific survival estimates were 36% (95% confidence interval [CI] 25-52%) for SkM+ and 66% (95% CI 55-80%) for matched SkM- patients (p < 0.001). On multivariable Cox regression analysis, SkM presence was an independent predictor for higher CSM (hazard ratio 2.05, 95% CI 1.06-4,12; p = 0.03).
PSCC-related SkM is associated with aggressive disease behaviour and poor survival outcomes. Palpation of the entire penile shaft is essential, and distant staging is recommended in patients suspected of having SkM owing to the tendency for distant metastatic spread.
We investigated outcomes for patients with cancer of the penis who had metastases in the tissues responsible for erection. We found that metastases in this location were associated with poor prognosis, even in the absence of more typical spread of cancer via the lymph nodes.
European urology oncology. 2023 Oct 07 [Epub ahead of print]
Laura Elst, Manon T A Vreeburg, Hielke Martijn de Vries, Kaat Vandermaesen, Titus Murphy, James Churchill, Giuseppe Fallara, Darren Sanchez, Marco Falcone, Herney Andres Garcia-Perdomo, Curtis Pettaway, Oliver Hakenberg, Peter Johnstone, Philippe E Spiess, Asif Muneer, Vijay Sangar, Arie Parnham, Benjamin Ayres, Nick Watkin, Oscar R Brouwer, Maarten Albersen
Department of Urology, University Hospitals Leuven, Leuven, Belgium; Young Academic Urologists Working Group on Penile and Testis Cancer, Arnhem, The Netherlands., Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Young Academic Urologists Working Group on Penile and Testis Cancer, Arnhem, The Netherlands; Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Penile Cancer Centre, St. George's University Hospitals NHS Trust, London, UK., Department of Urology, The Christie NHS Foundation Trust, Manchester, UK., Young Academic Urologists Working Group on Penile and Testis Cancer, Arnhem, The Netherlands; Male Genital Cancer Centre, Department of Urology, NIHR Biomedical Research Centre University College London Hospitals, London, UK; Department of Urology, IRCCS European Institute of Oncology, Milan, Italy., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, Molinette Hospital, University of Torino, AOU Città della Salute e della Scienza di Torino, Turin, Italy., Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia., Department of Urology, University Medical Center Rostock, Rostock, Germany., Departments of Radiation Oncology and Urology, Moffitt Cancer Center, Tampa, FL, USA., Male Genital Cancer Centre, Department of Urology, NIHR Biomedical Research Centre University College London Hospitals, London, UK., Department of Urology, University Hospitals Leuven, Leuven, Belgium. Electronic address: .