PURPOSE: We aimed to determine the predictors of pelvic lymph-node metastases (LNM) in patients with penile cancer.
METHODS: A total of 188 node-positive inguinal groins from 142 patients treated for penile cancer were retrieved. Logistic regression models (LRMs) were fitted to test the predictors of pelvic LNM. The minimum p-value method was used to determine the most significant cut-off values for each predictor.
RESULTS: Pelvic LNM were observed in 45 (31.7%) cases. Five-year cancer-specific survival (CSS) rates were 71.0% vs. 33.2% in patients with inguinal vs. pelvic LNM. The most significant cut-off values were 3 and 30 mm for the number and diameter of inguinal LNM. From the univariable LRMs, the number of inguinal LNM (OR: 1.92; p< 0.001), the diameter of inguinal LNM (OR: 1.03; p=0.001), and the presence of extra-nodal extension (ENE) (OR: 8.01; p< 0.001) emerged as significant predictors of pelvic LNM. In addition, these variables were independent predictors of pelvic LNM in multivariable LRMs (p≤ 0.012). Patients with ≥3 inguinal LNM and patients with a LNM diameter ≥30 mm had respectively a 4.77- and 2.53-fold higher risk of harboring pelvic LNM (p≤ 0.006). The proportion of pelvic LNM significantly increased from 0% in cases with no risk factors to 57.1% when all of the three risk factors were observed (p< 0.001).
CONCLUSIONS: Number and diameter of inguinal LNM, as well as ENE, are significantly associated with pelvic LNM. These variables should be taken into account to determine the need of pelvic lymph-node dissection. Patients with no risk factors may be spared pelvic lymph-node dissection.
Written by:
Giovanni L, Mario C, Tullio T, Luigi P, Davide B, Silvia S, Andrea G, Crestani A, Daniele R, Patrizia G, Andrea N, Giorgio P, Maurizio C, Roberto S, Nicola N. Are you the author?
Department of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
Reference: J Urol. 2013 Nov 18. pii: S0022-5347(13)05978-8.
doi: 10.1016/j.juro.2013.10.140
PubMed Abstract
PMID: 24262497
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