Predicting Pelvic Lymph-Node Metastasis in Carcinoma Penis: A Meta-Analysis of Retrospective Studies

Pelvic lymph node dissection (PLND) in penile squamous cell carcinoma (PSCC) adds to morbidity, which can be avoided if certain predictors are available for PLND. This meta-analysis was planned to determine the significant predictors for PLND in PSCC. A comprehensive search was performed through PubMed, Embase database and Google scholar through July 2024. Odds-ratios (ORs) along with their corresponding 95% confidence-intervals (CIs) were analyzed. All analyses were done using Review Manager software version 5.3. Eight retrospective studies involving 985 patients were included. Key predictors of pelvic lymph node metastasis (PLNM) included extra-nodal extension (ENE) (OR 3.76, 95% CI 2.35-6.01, P = .0003) and involvement of more than 2 inguinal lymph nodes (OR 5.36, 95% CI 2.64-10.84, P = .0008). Strong p53 immunoreactivity was linked to PLNM (OR 9.18, 95% CI 0.00-330,643.0, P = .227). The ratio of ≥ 30% positive inguinal nodes and PLNM showed a positive correlation but was insignificant (OR 33.7, 95% CI 0.00-16,496,970.0, P = .181). Inguinal lymph node metastasis in > 2 nodes and ENE of tumor are significant predictors of PLNM. Tumor histology grade, percentage of positive inguinal lymph nodes dissected, pathological tumor stage, lymphovascular invasion and maximum size of metastatic inguinal lymph node were insignificant in predicting PLNM. We conclude that the pelvic lymph node dissection should be guided by these risk factors.