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Prophylactic pelvic lymph node dissection in patients with penile cancer
Rosa S Djajadiningrat1, Erik van Werkhoven1, Simon Horenblas1
1Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute, Amsterdam, The Netherlands.
The Journal of Urology
|December 16, 2014
Summary
Penile cancer patients with extranodal extension or ≥2 positive inguinal lymph nodes are at high risk for pelvic lymph node metastasis. Survival remains poor for those with pelvic involvement despite prophylactic surgery.
Area of Science:
- Oncology
- Urology
- Surgical Oncology
Background:
- Pelvic lymph node involvement in penile cancer significantly worsens prognosis.
- The role of prophylactic pelvic lymph node dissection (pPLND) is debated due to its curative potential versus morbidity.
- Identifying predictors for pelvic lymph node metastasis is crucial for treatment decisions.
Purpose of the Study:
- To identify characteristics of tumor-positive inguinal regions that predict pelvic lymph node involvement.
- To analyze outcomes in patients undergoing prophylactic pelvic lymph node dissection for penile cancer.
Main Methods:
- Retrospective analysis of 79 chemotherapy-naïve penile cancer patients treated with pPLND since 2001.
- Generalized estimating equation model to predict pelvic node positivity based on inguinal characteristics.
- Disease-specific survival (DSS) calculated using the Kaplan-Meier method.
Main Results:
- 24% of patients had positive pelvic lymph nodes.
- Inguinal extranodal extension and ≥2 positive inguinal lymph nodes were significant predictors of pelvic node positivity.
- 5-year DSS for patients with pelvic involvement was 17%.
Conclusions:
- Inguinal extranodal extension or ≥2 positive inguinal lymph nodes predict pelvic lymph node positivity in penile cancer patients without preoperative evidence of pelvic disease.
- Despite prophylactic surgery, disease-specific survival remains poor for patients with confirmed pelvic lymph node involvement.
