Lymphovascular and perineural invasion are risk factors for inguinal lymph node metastases in men with T1G2 penile cancer

Fankhauser, Christian Daniel; Vries, Hielke M. de; Roussel, Eduard; Jakobsen, John; Issa, Allaudin; Lee, Esther W. C.; Schifano, Nicolò; Alnajjar, Hussain M.; Castiglione, Fabio; Antonelli, Luca; Oliveira, Pedro; Lau, Maurice; Parnham, Arie; Albersen, Maarten; Watkin, N.; Muneer, Asıf; Ayres, Ben; Brouwer, O.R.; Sangar, Vijay

doi:10.1007/s00432-022-04012-2

Cited by 9 publications

(4 citation statements)

References 11 publications

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“…Other studies have shown moderate differentiation to be an independent prognostic factor relative to well differentiation. 30,31 The 3% vs 10% unadjusted 5-year metastasis risk in well vs moderately differentiated tumors in the present study indicates moderate differentiation may be a poor prognostic factor relative to well differentiation, though weaker than diameter and depth in these data, and a larger study would be needed to prove its contribution. Tumor diameter and depth are chief components of current staging and did improve the model’s AIC, so the models reported herein were adjusted for these factors.…”

Section: Discussionmentioning

confidence: 62%

“…Based on data showing PDEMA to have superior outcomes for cutaneous SCC we sought to determine if there are differences in outcomes in patients with low-stage (in situ and T1a disease) PSCC treated with PDEMA compared with other surgical treatment (circumcision/ excision and penectomy/glansectomy). What We Found: In our cohort of 189 patients, primary PSCCs were excised with PDEMA (N [ 30), excision/circumcision (N [ 110), or penectomy/ glansectomy (N [ 49). Of patients treated with traditional margin assessment (non-PDEMA), 12% had narrow or positive margins.…”

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confidence: 99%

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Total Margin Control Is Superior to Traditional Margin Assessment for Treatment of Low-Stage Penile Squamous Cell Carcinoma

O’Connell,

Thomas,

Murad

et al. 2024

Journal of Urology

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Purpose:Penile cancer is rare, with significant morbidity and limited literature assessing utility of peripheral and deep en face margin assessment (PDEMA) vs traditional margin assessment (vertical sections) on treatment outcomes.Materials and Methods:This was a 32-year retrospective multicenter cohort study at 3 academic tertiary care centers. The cohort consisted of 189 patients with histologic diagnosis of in situ or T1a cutaneous squamous cell carcinoma of the penis at Brigham and Women’s, Massachusetts General Hospital (1988-2020), and Memorial Sloan Kettering Cancer Center (1995-2020) treated with PDEMA surgical excision, excision/circumcision, or penectomy/glansectomy. Local recurrence, metastasis, and disease-specific death were assessed via multivariable Cox proportional hazard models.Results:The cohort consisted of 189 patients. Median age at diagnosis was 62 years. Median tumor diameter was 1.3 cm. The following outcomes of interest occurred: 30 local recurrences, 13 metastases, and 5 disease-specific deaths. Primary tumors were excised with PDEMA (N = 30), excision/circumcision (N = 110), or penectomy/glansectomy (N = 49). Of patients treated with traditional margin assessment (non-PDEMA), 12% had narrow or positive margins. Five-year proportions were as follows with respect to local recurrence-free survival, metastasis-free survival, and disease-specific survival/progression-free survival, respectively: 100%, 100%, and 100% following PDEMA; 82%, 96%, and 99% following excision/circumcision; 83%, 91%, and 95% following penectomy/glansectomy. A limitation is that this multi-institutional cohort study was not externally validated.Conclusions:Initial results are encouraging that PDEMA surgical management effectively controls early-stage penile squamous cell carcinoma.

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Section: Discussionmentioning

confidence: 62%

mentioning

confidence: 99%

Total Margin Control Is Superior to Traditional Margin Assessment for Treatment of Low-Stage Penile Squamous Cell Carcinoma

O’Connell,

Thomas,

Murad

et al. 2024

Journal of Urology

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“…The most popular surgical options are Superficial Inguinal Lymph Node Dissection (SILD) at 31.3%, Dynamic Sentinel Lymph Node Biopsy (DSNB) at 28.4%, Modified Inguinal Lymph Node Dissection (MILD) at 26.4%, and Video-Endoscopic Inguinal Lymphadenectomy (VEIL) at 13.7%. According to a retrospective study conducted by Fankhauser et al [76 ▪▪ ], approximately 8% of patients with pT1G2 PeCa have lymphonodal metastasis, finding an increasing risk of detecting it if the histological report indicates the presence of Perineural invasion (PNI+) or lymphovascular invasion (LVI+). Robotic-assisted inguinal lymphadenectomy (RAIL) is showing slight improvements in perioperative outcomes compared with videolaparoscopy [77 ▪ ], which will lead to a steady increase in robot-assisted surgery as seen in other urology fields [78].…”

Section: Adherence To Guidelines and Centralization Of Carementioning

confidence: 99%

Organ-sparing treatment for T1 and T2 penile cancer: an updated literature review

Scornajenghi

Asero

Bologna

et al. 2023

Current Opinion in Urology

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Purpose of reviewPenile cancer (PeCa) is an orphan disease due to its rare incidence in high-income countries. Traditional surgical options for clinical T1--2 disease, including partial and total penectomy, can dramatically affect patient's quality of life and mental health status. In selected patients, organ-sparing surgery (OSS) has the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of various OSSs currently available for men diagnosed with PeCa seeking an organ-preserving option. Recent findingsPatient survival largely depends on spotting and treating lymph node metastasis at an early stage. The required surgical and radiotherapy skill sets cannot be expected to be available in all centers. Consequently, patients should be referred to high-volume centers to receive the best available treatments for PeCa. SummaryOSS should be used for small and localized PeCa (T1-T2) as an alternative to partial penectomy to preserve patient's quality of life while maintaining sexual and urinary function and penile aesthetics. Overall, there are different techniques that can be used with different response and recurrence rates. In case of tumor recurrence, partial penectomy or radical penectomy is feasible, without impacting overall survival.

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“…A positive ultrasound and FNAC reduces the need for dynamic sentinel lymph node biopsy (DSNB) and enables earlier curative ILND. Unfortunately, a negative ultrasound cannot exclude the presence of micro-metastatic disease and the risk of occult metastases in inguinal lymph nodes is 6–30% [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of dynamic sentinel lymph node biopsy for inguinal lymph node staging in cN0 penile cancer

et al. 2023

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Background Penile cancer is characterized by an early lymphatic dissemination. In intermediate and high-risk primary tumors without palpable inguinal lymph nodes, there is a 6–30% risk of micro-metastatic disease. Invasive lymph node staging in these patients is performed using dynamic sentinel lymph node biopsy (DSNB). In this study, the role of DSNB in cN0 penile cancer was studied, evaluating features of sentinel lymph node (SN) visualization and outcome parameters. Patients with penile cancer without inguinal lymph node metastases who were referred for DSNB at our center between January 2015 and May 2021 and had a follow-up period of at least 18 months, were retrospectively included. After injection of 85 ± 20 MBq [99mTc]Tc-nanocolloid peritumorally, dynamic, static planar and SPECT/CT imaging was performed. Primary endpoints were sensitivity of the diagnostic procedure, disease-free survival and DSNB-related adverse events. Secondary endpoints were SN detection rate, number of SNs and the number of counts of the most active SN. Results Seventy-seven penile DSNB procedures in 75 patients (67 ± 11 years) were included. The detection rate of DSNB was 91% and 96% per procedure and groin, respectively. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were 79%, 100%, 97% and 100%, respectively. More SNs were seen on SPECT/CT than on static planar imaging (1.33 vs. 1.17, p = 0.001). The mean counts per SN on static planar imaging was lower compared to SPECT/CT (1343 vs. 5008; p < 0.0001). There was a positive correlation between the total counts of the SN on the static planar image and the SPECT/CT (r = 0.79, p < 0.0001). Only one out of seventy-five patients (1%) experienced DSNB-related adverse events. After 18 months, 58 patients remained disease free (77%), 13 developed local recurrence (17%), and 4 developed lymphatic or distant metastases (5%). Conclusion DNSB is a safe diagnostic procedure with a good detection rate and in particular high negative predictive value. It can therefore prevent overtreatment of patients with negative inguinal groins on clinical examination and DSNB examination. Finally, DSNB enables an early detection of occult metastases which would not be visualized with standardized imaging modalities.

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Lymphovascular and perineural invasion are risk factors for inguinal lymph node metastases in men with T1G2 penile cancer

Cited by 9 publications

References 11 publications

Total Margin Control Is Superior to Traditional Margin Assessment for Treatment of Low-Stage Penile Squamous Cell Carcinoma

Total Margin Control Is Superior to Traditional Margin Assessment for Treatment of Low-Stage Penile Squamous Cell Carcinoma

Organ-sparing treatment for T1 and T2 penile cancer: an updated literature review

Accuracy of dynamic sentinel lymph node biopsy for inguinal lymph node staging in cN0 penile cancer

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