Identifying an optimal lymph node yield for penile squamous cell carcinoma: prognostic impact of surgical dissection

Abstract

Objective To evaluate the prognostic impact of lymph node yield (LNY) on survival outcomes for penile squamous cell carcinoma (SCC). Patients and methods In all, 532 patients who underwent inguinal LN dissection (ILND) across tertiary referral centres from Europe, China, Brazil and North America were retrospectively evaluated. From this cohort, 198 patients received pelvic LND (PLND).We identified threshold values for ILND and PLND using receiver operating characteristic curves. We tested prognostic value of LNY for recurrence‐free survival (RFS), disease‐specific survival (DSS), and overall survival (OS) using the Kaplan–Meir method and Cox proportional hazard regression models. Results The median (interquartile [IQR]) age was 59 (49–68) years and the median (IQR) follow‐up after ILND was 28 (12–68.2) months. Overall, 85% of the patients had bilateral dissections. The median (IQR) number of inguinal LNs removed was 15 (10–22). Of those receiving PLND, The median (IQR) number of LNs was 13 (8–19). A LNY of ≥15 was used for dichotomisation of ILND patients, and a LNY of ≥9 was used in the PLND cohort. Patients with a LNY ≥15 had significantly better 5‐year OS vs patients with a LNY <15 (70.1% vs 58.7%). On multivariable analyses, a LNY ≥15 was a predictor of OS (hazard ratio [HR] 0.68, P = 0.029). For cN0 patients, a LNY ≥15 was an independent predictor of RFS (HR 0.52, P = 0.043) and OS (HR 0.53, P = 0.021). In the PLND cohort, a LNY ≥9 was a predictor of RFS (HR 0.53, P = 0.032). Conclusions Using one of the largest LND datasets to date, we found LNY to be a significant predictor of outcomes after lymphatic staging for penile SCC. Prospective validation is warranted.

A risk calculator predicting recurrence in lymph node metastatic penile cancer

“…Our risk calculator established and validated the importance of three prognostic factors, namely pN 3 status, ILNM ratio and surgical margin status of the penile lesion. Although these factors have previously been found to be associated with an increased risk of cancer recurrence and adverse outcomes [18–21], we proved their independent correlation with recurrence, and developed an easy‐to‐use, readily accessible risk stratification tool. Moreover, the realisation of the risk calculator‐derived tertiles serves as a practical example of how the risk groups can be abstracted in clinical practice.…”

Is There an Oncological Benefit of Performing Bilateral Pelvic Lymph Node Dissection in Patients with Penile Cancer and Inguinal Lymph Node Metastasis?

“…Moreover, a lymph node yield of ≥9 was found to be a predictor for RFS after adjustment for baseline characteristics. Although a distinction of DSS, OS, and RFS differences in patients that underwent unilateral as opposed to bilateral PLND was not undertaken, this study established an LN threshold that may be more readily obtained with bilateral dissections and that may provide a benefit in patients harboring pelvic LNM [11].…”

“…Chipollini et al performed PLND in 198 chemonaïve patients, of which 106 (53.5%) were bilateral dissections. The median number of lymph nodes (LN) and the median number of positive LN were 13 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)) and 2 (1-4), respectively. The survival analysis revealed that patients with a lymph node yield of ≥9 LN had better 5-year disease-specific survival (DSS) (64.2% vs. 47.2%), overall survival (OS) (60.3% vs. 39.8%), and recurrencefree survival (RFS) (60.3% vs. 43.2%).…”

Optimising the selection of candidates for neoadjuvant chemotherapy amongst patients with node‐positive penile squamous cell carcinoma

“…Prognosis of patients harbouring pSCC is largely influenced by the initial stage of the disease, ranging from long survival in penile‐localised tumours treated by immediate surgery [1], to rapidly progressive disease in lymph node metastatic cases [2,3]. In this context, the identification of palpable groin lymph node metastases has been regarded as one of the most important predictors of poor overall survival (OS) [4].…”

“…Using one of the largest multi‐institutional database of patients with pSCC [4,18,19], we aimed to identify the optimal candidates for NAC amongst cN+ patients. We focussed on patients with pSCC with palpable and/or imaging‐detected groin lymph node metastases, who underwent local excision and inguinal lymph node dissection (ILND).…”