Extensive inguinal lymphadenectomy improves overall 5‐year survival in penile cancer patients

Abstract

BACKGROUND: European Urological Association guidelines recommend potentially curative inguinal lymphadenectomy for certain cases of penile cancer such as grade 3 and pT2-4 lesions, among others. Anecdotally, the authors have noticed that few patients undergo inguinal lymphadenectomy. Therefore, they assessed the frequency of inguinal lymphadenectomy and the impact of dissection extent on survival using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS: The authors queried 17 SEER registries from 1988 through 2005 for grade 3 and pT2-4 penile cancer patients without distant metastases. Univariate and multivariate analyses examined predictors of inguinal lymphadenectomy. Kaplan-Meier and Cox regression analyses assessed overall 5-year survival across patientand disease-related characteristics for patients receiving inguinal lymphadenectomy involving <8 or 8 lymph nodes, the latter a surrogate for extent of dissection based on other malignancies. RESULTS: Of 593 patients enrolled, only 26.5% received inguinal lymphadenectomy. In addition to grade 3 (P ¼ .031) and pT2-4 disease (P ¼ .004), age <65 years (P < .001) and marital status (P ¼ .002) were significantly associated with receiving lymph node dissection. Increased overall 5-year survival (hazard ratio, 0.54; 95% confidence interval, 0.36-0.79) was observed in patients of all ages who received lymphadenectomy involving 8 lymph nodes. CONCLUSIONS: A significant number of penile cancer patients at risk for metastases have not received potentially curative inguinal lymphadenectomy. Patients receiving inguinal lymphadenectomy involving 8 lymph nodes experienced improved overall 5-year survival. Guidelines should not only be given more emphasis, but possibly be updated to reflect the benefit of extensive lymph node dissection in high-risk penile cancer patients. Cancer 2010;116:2960-6.

Population-Based Assessment of the Number of Lymph Nodes Removed in the Treatment of Penile Squamous Cell Carcinoma

“…After adjusting demographic characteristics and tumor-related factors, increasing age remained a significant association with limited LND. Our findings were in line with previously reported observations that the complication rate of LND was considerably low in elderly patients [7,14]. These observations raise the perception that certain factors may potentially deter surgeons from performing a thorough procedure for elderly patients.…”

“…Consistent with a previous report [14], a survival benefit was observed in patients who received extensive LND. Interestingly, we found a trend of better survival in the subgroup of node-negative cases: the 5-year CSS was 82 and 94.6% in those treated with limited and extensive LND, respectively.…”

“…Inguinal LND is the treatment of choice for patients with clinically apparent lymph node metastasis, and is recommended for those at high risk of developing occult nodal disease [4,5,6]. Johnson et al [14] had previously analyzed the SEER database to explore various factors associated with receiving LND. The authors also reported improved survival of patients undergoing extensive LND, as compared with those receiving limited or no surgery.…”

A nyaki dissectiók onkológiai hozamának maximalizálása a sebészi morbiditás egyidejű minimalizálása mellett

“…Rövidítések CI = konfidenciaintervallum; CRT = kemoradioterápia; cTNM = klinikai tumorstádium-meghatározás; DÖSAK = Deutsch-Österreichisch-Schweizerischer Arbeitskreis für Tumoren im Kiefer-und Gesichtsbereich; ECS, ECE = nyirokcsomó-metasztázis extrakapszuláris terjedése; LNR = lymph node ratio: a hisztológiailag érintettnek bizonyult nyirokcsomók számának és az összes eltávolított nyirokcsomók számának há-nyadosa; pTNM = kórszövettani tumorstádium-meghatározás; RTOG = Radiation Therapy Oncology Group; TOS = transorális sebészet Az onkológiai sebészetben ismert tény, hogy a regionális lymphadenectomiák során begyűjtött abszolút nyirokcsomószám, az úgynevezett nyirokcsomóhozam (nodal yield) független prognosztikai faktor a vastagbél [1,2], a rectum [3], a húgyhólyag [4][5][6], a prosztata [7], a hím-vessző [8], a nyelőcső [9], a gyomor [10] és az emlő daganatai esetében [11]. Ezen prognosztikai faktor alkalmazható a kimutatható nyirokcsomó-metasztázis nél-küli esetekre is, azaz független a nyirokcsomók metasztatikus érintettségétől [12].…”

Management of carcinoma of the penis: Consensus statement from the Canadian Association of Genitourinary Medical Oncologists (CAGMO)

“…No Canadian guidelines or consensus statements currently exist to guide the diagnosis and management of these patients. The European Association of Urology (EAU) has published guidelines on the management approach to penile cancer, but recent data published by Johnson and collegues 6 suggest that these recommendations have not been widely applied in North America. 5,6 Our objective was to develop the first Canadian Consensus Statement on the management of penile cancer for Canadian oncologic specialists treating genitourinary cancers based on available evidence, existing guidelines and expert Canadian opinion to better address the needs of patients with penile cancer in Canada.…”