PURPOSE: Penile carcinoma (PC) with bilateral pelvic lymph nodes metastasis (BiPL-LNM) is a relatively rare condition with poor outcomes.
There is little data available on optimal strategies for staging and management of this group of patients. Here we aim to assess factors predicting BiPL-LNM in penile cancer patients with confirmed inguinal LNM.
MATERIALS AND METHODS: Multi institutional data from four centers in Europe, China and United States were retrospectively analyzed. Patients with PC and inguinal LNM who underwent bilateral pelvic lymphadenectomy were included. Kaplan-Meier and Log Rank tests were used to express overall survival (OS). Logistic regression was used for multivariate analysis of factors predicting BiPL-LNM and Cox regression in multivariable analysis for OS.
RESULTS: 140 PC patients with confirmed pelvic LNM were identified. 83 had bilateral inguinal LNM and 64 had bilateral pelvic lymphadenectomy. BiPL-LNM was observed in 16 (25%) patients. ROC for total number of inguinal LNM and detection of BiPL-LNM had AUC of 0.76 (p=0.002), with sensitivity of 95% for cut-off point of four inguinal nodes. On Logistic regression analysis, detection of 4 or more positive inguinal nodes was the only independent predictor of BiPL-LNM (OR: 14.0 [CI 1.71-115]). In Cox regression analysis, presence of 4 or more inguinal LNM, adjuvant chemotherapy, inguinal ENE and bilateral procedures were associated with OS.
CONCLUSIONS: Patients with bilateral inguinal LNM who are being treated with a unilateral pelvic LAD, should be considered for bilateral pelvic lymphadenectomy in presence of 4 or more metastatic inguinal nodes.
Written by:
Zargar-Shoshtari K, Djajadiningrat R, Sharma P, Catanzaro M, Zhu Y, Nicolai N, Horenblas S, Spiess PE. Are you the author?
Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, FL, USA; Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Department of Urology, Amsterdam, The Netherlands; Fondazione IRCCS Istituto Nazionale Tumori, Department of Urology, Milano, Italy; Fudan University Shanghai Cancer Center, Department of Urology, Shanghai, China.
Reference: J Urol. 2015 Mar 20. pii: S0022-5347(15)03388-1.
doi: 10.1016/j.juro.2015.03.090
PubMed Abstract
PMID: 25801766