Angiolymphatic invasion and absence of koilocytosis predict lymph node metastasis in penile cancer patients and might justify prophylactic lymphadenectomy

Abstract

To analyze possible clinical–pathological parameters and predictors of lymph node metastasis and evaluate the impact of lymphadenectomy in the survival of these patients. A retrospective study of patients diagnosed with penile cancer and submitted to regional lymphadenectomy at two reference hospitals in Maranhão, Northeast, Brazil, an area where the disease has a high incidence. We described here clinical and histopathological characteristics of patients diagnosed between January 2009 and September 2017. Fifty-five patients with an average age of 55.4 years (range: 25–84 years) were analyzed, with 24.4 months being the average time between the onset of symptoms and start of treatment. Among patients without palpable lymph nodes at the first examination, 51% were affected by inguinal metastasis. In the multivariate analysis, the presence of angiolymphatic invasion ( P = .029) and absence of koilocytosis ( P = .001) were found to be predictive factors for lymph node metastasis. Patients submitted to prophylactic lymphadenectomy presented with a disease-free period of 25.4 months (±5.81), whereas those who underwent therapeutic lymphadenectomy presented with a disease-free period of 19.9 months (±3.12). Angiolymphatic invasion and absence of koilocytosis appeared to be predictive factors for lymph node metastasis. Therefore, the submission of patients with metastatic risk to prophylactic lymphadenectomy may improve their survival. Thus, prophylactic lymphadenectomy in patients at risk for inguinal metastasis may create a positive impact in survival rates.

A comprehensive analysis of penile cancer in the region with the highest worldwide incidence reveals new insights into the disease

“…De-Paula et al (2007) observed the presence of koilocytosis in 63.1% of the PC samples evaluated, being associated with tumors with low or moderate staging and better DFS [ 60 ]. In Maranhão, Nascimento et al (2020) described angiolymphatic invasion and absence of koilocytosis as predictive factors for lymph node metastasis [ 10 ], corroborating previous findings by Ornellas et al (2008) [ 61 ]. However, in the present study, we found no difference in DFS between the groups with and without koilocytosis, as well as no association between koilocytosis and lymph node metastasis.…”

Prognostic predictors of lymph node metastasis in penile cancer: a systematic review

“…Specifically, in a cohort of 400 patients, they showed a 39% higher sentinel node detection rate, further increasing the sensitivity of this nodal detection measure and its clinical utility (13). Interestingly, one study showed that absence of koilocytosis (seen in epithelial cells with HPV infection) was predictive of metastasis; specifically, 32.2% of patients with histological koilocytosis had positive nodes compared to 82% without koilocytosis (14). Also, a more easily obtained, but less studied factor that correlates with metastasis is the apparent diffusion coefficient (ADC) on diffusion-weighted MRI (DW-MRI) of the primary tumor, which shows the changes in proton mobility when there is underlying pathology or tissue alteration.…”

Factors Predicting Nodal Metastasis in Penile Cancer: Analysis from a Tertiary Center

“…A recent metaanalysis has shown an increased risk of inguinal lymph node metastasis and a higher cancer-specific mortality associated with presence of PNI especially in younger patients [21]. Even though various authors have questioned its role as an independent prognostic factor, it has been included in the AJCC TNM 8th edition staging manual [11,22,23]. Similar to that in malignant melanoma, Emerson et al [24] suggested the role of depth of invasion in penile cancer and tumor progression.…”