Nomograms to predict the presence and extent of inguinal lymph node metastasis in penile cancer patients with clinically positive lymph nodes

Background: The aim of this study is to determine the necessary extent of penile lymph node dissection (PLND) in penile cancer patients with inguinal lymph node extracapsular extension (ILN-ENE).Methods: Penile cancer patients who underwent PLND in 15 centers from January 2006 to April 2020 were retrospectively analyzed. PLND was performed in patients with ILN-ENE.Results: Sixty-two patients with ILN-ENE were included in the analysis. A total of 51.6% (32/62) of the patients were confirmed to have pelvic lymph node metastasis (PLNM), and 31.3% (10/32) of patients were confirmed to have multiple PLNMs. Of the patients with metastases, 59.4% (19/32) had bilateral inguinal lymph node metastasis (ILNM). According to the anatomical structure, 71.9% (23/32) of the patients had PLNM in the external iliac region, and 56.2% (18/32) had PLNM in the obturator region. Among those with oligo-PLNM, 65.1% (28/43) of the patients had PLNM in the external iliac region and 38.9% (15/43) had PLNM in the obturator region. A significant overall survival difference was observed between patients with the bilateral ILNM and unilateral ILNM (36-month: 21.2 vs. 53.7%, respectively, P = 0.023). Patients with bilateral ILNM had relatively poor metastasis-free survival compared with unilateral ILNM (36-month: 33.0 vs. 13.9%, respectively, P = 0.051).Conclusions: The external iliac and obturator region were the most commonly affected regions in patients with ILN-ENE, and these regions were the only affected regions in patients with oligo-PLNM. Patients with bilateral ILNM had a high risk of PLNM and worse survival.

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Is There an Oncological Benefit of Performing Bilateral Pelvic Lymph Node Dissection in Patients with Penile Cancer and Inguinal Lymph Node Metastasis?

Journal of Clinical Medicine ◽

10.3390/jcm10040754 ◽

2021 ◽

Vol 10 (4) ◽

pp. 754

Author(s):

Rodrigo Suarez-Ibarrola ◽

Mario Basulto-Martinez ◽

August Sigle ◽

Mohammad Abufaraj ◽

Christian Gratzke ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Node Dissection ◽

Penile Cancer ◽

Inguinal Lymph Node ◽

Pelvic Lymph Node Dissection ◽

Pelvic Lymph Node ◽

Node Dissection ◽

Inguinal Lymph Node Metastasis ◽

Node Metastasis

We aim to review the literature for studies investigating the oncological outcomes of patients with penile cancer (PC) undergoing bilateral pelvic lymph node dissection (PLND) in the presence of inguinal lymph node metastasis (LNM) who are at risk of harboring pelvic metastasis. A search of English language literature was performed using the PubMed-MEDLINE database up to 3 December 2020 to identify articles addressing bilateral PLND in PC patients. Eight articles investigating bilateral PLND met our inclusion criteria. Patients with pelvic LNM have a dismal prognosis and, therefore, PLND has an important role in both the staging and treatment of PC patients. Ipsilateral PLND is recommended in the presence of ≥2 positive inguinal nodes and/or extranodal extension (ENE). Significant survival improvements were observed with a higher pelvic lymph node yield, in patients with pN2 disease, and in men treated with bilateral PLND as opposed to ipsilateral PLND. Nevertheless, the role of bilateral PLND for unilateral inguinal LNM remains unclear. Although the EAU guidelines state that pelvic nodal disease does not occur without ipsilateral inguinal LNM, metastatic spread from one inguinal side to the contralateral pelvic side has been reported in a number of studies. Further studies are needed to clarify the disseminative pattern of LNM, in order to establish PLND templates according to patients’ risk profiles and to investigate the benefit of performing bilateral PLND for unilateral inguinal disease.

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Predictive Factors of Inguinal Lymph Node Metastasis in Men with Penile Cancer at Sanglah Hospital, Denpasar, Bali

JBN (Jurnal Bedah Nasional) ◽

10.24843/jbn.2017.v01.i02.p02 ◽

2017 ◽

Vol 1 (2) ◽

pp. 39

Author(s):

AK Harmaya ◽

IW Yudiana ◽

AAG Oka ◽

W Djatisoesanto

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Predictive Factors ◽

Primary Tumor ◽

Vascular Invasion ◽

Penile Cancer ◽

Inguinal Lymph Node ◽

Inguinal Lymph Node Metastasis ◽

Node Metastasis ◽

Pathologic Stage

Objective: to know the predictive factors of inguinal lymph node metastasis in men with penile cancer. Methods: this was a retrospective study on 65 patients with penile cancer in Sanglah Hospital, Denpasar, Bali from 2011 to 2015. Patients were included in analysis if they had undergone partial or total penectomy, and inguinal lymph-node dissection or excisional biopsy. Inguinal lymph node metastasis was defined as tumor positive node based on histopathology finding in patients who underwent inguinal lymph node dissection or excisional biopsy. Data retrieved from this study was analyzed by Chi Square and Kruskal-Wallis test. Results: a total of 65 patients diagnosed as penile cancer in Sanglah Hospital, Denpasar, Bali from 2011 to 2015. Mean age of these patients was 53.24 ± 13.42 years. The youngest age was 27 years old and the oldest was 86 years old. Fifteen patients were excluded for different reasons, remaining 50 patients for further analysis. From 50 patients included in analysis, 25 patient (50%) had inguinal lymph node metastasis. There were significant correlation between pathologic stage of the primary tumor (p=0.021), histologic grade (p=0.020), and vascular invasion (p=0.008) with the presence of inguinal lymph node metastasis. Based on pathologic stage of the primary tumor, only 1 of 7 patients (14%) with pT1 had inguinal lymph node metastasis compared with 10 of 24 patients (42%) with pT2, 10 of 15 patients (67%) with pT3, and 4 of 4 patients with pT4 (100%). Based on histologic grade, only 2 of 9 patients (22%) with grade I had inguinal lymph node metastasis compared with 18 of 36 patients (50%) with grade II, and 5 of 5 patients (100%) with grade III. Based on vascular invasion, only 15 of 38 patients (39%) without vascular invasion had inguinal lymph node metastasis compared with 10 of 12 patients (83%) with vascular invasion. No significant correlation was found between age and the presence of inguinal lymph node metastasis (p=0.829). Conclusion: pathologic stage of the primary tumor, histologic grade, and vascular invasion were predictive factors of inguinal lymph node metastasis in men with penile cancer.

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