Lymph node density predicts recurrence and death after inguinal lymph node dissection for penile cancer

Area of Science:

• Oncology
• Urology
• Surgical Pathology

Background:

• Penile cancer prognosis is influenced by lymph node metastasis.
• Inguinal lymph node dissection (ILND) is a critical staging and therapeutic procedure.
• The prognostic value of lymph node density (LND) in penile cancer requires further elucidation.

Purpose of the Study:

• To assess the impact of lymph node density (LND) on survival outcomes following ILND in penile cancer patients.
• To compare the prognostic capability of LND against the total number of positive lymph nodes.

Main Methods:

• Retrospective analysis of a penile cancer database for patients who underwent ILND.
• Calculation of LND as the percentage of positive lymph nodes out of the total resected.
• Statistical analysis to determine the association between LND and recurrence-free survival (RFS) and overall survival (OS).

Main Results:

• A LND threshold of 15% was significantly associated with poorer RFS and OS.
• Patients with LND >15% had substantially lower median RFS and OS compared to those with LND ≤15%.
• LND >15% independently predicted worse RFS and OS, outperforming the total number of positive lymph nodes as a prognostic marker.

Conclusions:

• In penile cancer patients undergoing ILND, a lymph node density exceeding 15% is a significant predictor of adverse survival.
• LND is a more robust prognostic indicator than the absolute count of positive lymph nodes for predicting RFS and OS.
• These findings suggest LND should be considered in risk stratification and treatment planning for penile cancer.