Lymph node metastasis in intermediate-risk penile squamous cell cancer: a two-centre experience

Area of Science:

• Oncology
• Urology
• Surgical Pathology

Background:

• Penile cancer staging involves assessing lymph node metastasis risk.
• G2T1 penile cancer is classified as intermediate-risk by European Association of Urology (EAU) guidelines.
• Management of clinically node-negative (cN0) patients with intermediate-risk penile cancer is debated.

Purpose of the Study:

• To determine the precise risk of lymph node (LN) metastasis in G2T1 penile cancer.
• To evaluate the effectiveness and morbidity of different staging strategies for cN0 patients with G2T1 penile cancer.

Main Methods:

• Retrospective analysis of data from two penile cancer referral centers.
• Inclusion of 117 patients with G2T1 penile cancer from a cohort of 902.
• Comparison of outcomes for clinically node-positive (cN1) and cN0 patients, with cN0 patients undergoing inguinal lymph node dissection (iLND), dynamic sentinel lymph node biopsy (DSLNB), or observation.

Main Results:

• Overall, 13% of G2T1 patients had LN metastasis.
• In cN1 patients, 50% had positive LNs on iLND.
• In cN0 patients, the risk of LN metastasis was 9% (8% with DSLNB, 13% with observation).

Conclusions:

• The 9% risk of metastasis in cN0 G2T1 penile cancer patients warrants surgical staging.
• Prophylactic bilateral iLND is too morbid for this detection rate.
• Dynamic sentinel lymph node biopsy (DSLNB) is a less morbid alternative for staging G2T1 penile cancer.