SAN DIEGO, CA USA (UroToday.com) - Whether or not doing inguinal and/or pelvic lymphadenectomy, and also the extent of lymphadenectomy template in a setting of invasive penile cancer, can be challenging for the urologist and certainly can be a very morbid procedure for the patient.
In this study from Milan, Italy, authors aimed at determining the predictors of pelvic LNM in a single-institutional population of 261 patients with pathologically determined inguinal LNM. A concomitant pelvic LND was performed in case of clinically evident +N. In case of low-volume inguinal disease, the decision to perform a deferred pelvic LND was determined based on pathological inguinal nodes characteristics. Logistic regression models were used to evaluate the predictors of pelvic lymph nodes involvement.
Overall, pelvic nodal involvement was observed in 18.3% cases. The mean number of positive inguinal and pelvic lymph nodes was 1.9 (range: 1-8) and 1.2 (range: 0-12), respectively. Mean inguinal LNM volume was 3.3 cm (range: 1-10 cm). Two variables were found to be independent predictors of pelvic LNM in multivariable LRMs (p=0.022 and 0.029, respectively). The most significant cut-off values were 3 for the number of inguinal LNM and 4 cm for the volume of inguinal LNM, respectively. Patients with >=3 inguinal LNM had a 2.82-fold higher risk of harboring pelvic LNM compare to patients with <=2 inguinal LNM (95% CI: 1.45-5.49; p=0.002). Similarly, patients with an inguinal LNM >=4 cm had a 2.37-fold higher risk of harboring pelvic LNM relative to individuals with LNM < 4 cm (95% CI: 1.12-5.05; p=0.025). In the current series, no significant relationship was observed between the presence of extranodal extension of the disease and pelvic LNM (p=0.174).
Previous retrospective studies have shown that patients with pelvic nodal invasion have 5-year cancer specific survival of ~<15%. Although this is a retrospective institutional study, authors have shown again that precise evaluation and prompt management of lymph nodes in patients with invasive penile cancer is essential.
Presented by Mario Catanzaro, Giovanni Lughezzani, Nicola Nicolai, Tullio Torelli, Luigi Piva, Davide Biasoni, Silvia Stagni, Andrea Necchi, Patrizia Giannatempo, Daniele Raggi, Elena Farè, Maurizio Colecchia, and Roberto Salvioni at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Reza Mehrazin, MD
