Predictive Factors of Inguinal Lymph Node Metastasis in Men with Penile Cancer at Sanglah Hospital, Denpasar, Bali

Abstract

Objective: to know the predictive factors of inguinal lymph node metastasis in men with penile cancer. Methods: this was a retrospective study on 65 patients with penile cancer in Sanglah Hospital, Denpasar, Bali from 2011 to 2015. Patients were included in analysis if they had undergone partial or total penectomy, and inguinal lymph-node dissection or excisional biopsy. Inguinal lymph node metastasis was defined as tumor positive node based on histopathology finding in patients who underwent inguinal lymph node dissection or excisional biopsy. Data retrieved from this study was analyzed by Chi Square and Kruskal-Wallis test. Results: a total of 65 patients diagnosed as penile cancer in Sanglah Hospital, Denpasar, Bali from 2011 to 2015. Mean age of these patients was 53.24 ± 13.42 years. The youngest age was 27 years old and the oldest was 86 years old. Fifteen patients were excluded for different reasons, remaining 50 patients for further analysis. From 50 patients included in analysis, 25 patient (50%) had inguinal lymph node metastasis. There were significant correlation between pathologic stage of the primary tumor (p=0.021), histologic grade (p=0.020), and vascular invasion (p=0.008) with the presence of inguinal lymph node metastasis. Based on pathologic stage of the primary tumor, only 1 of 7 patients (14%) with pT1 had inguinal lymph node metastasis compared with 10 of 24 patients (42%) with pT2, 10 of 15 patients (67%) with pT3, and 4 of 4 patients with pT4 (100%). Based on histologic grade, only 2 of 9 patients (22%) with grade I had inguinal lymph node metastasis compared with 18 of 36 patients (50%) with grade II, and 5 of 5 patients (100%) with grade III. Based on vascular invasion, only 15 of 38 patients (39%) without vascular invasion had inguinal lymph node metastasis compared with 10 of 12 patients (83%) with vascular invasion. No significant correlation was found between age and the presence of inguinal lymph node metastasis (p=0.829). Conclusion: pathologic stage of the primary tumor, histologic grade, and vascular invasion were predictive factors of inguinal lymph node metastasis in men with penile cancer.

Histological subtype is a significant predictor for inguinal lymph node metastasis in patients with penile squamous cell carcinoma

“…PSCC spreads mainly through the lymphatic system to inguinal and pelvic lymph nodes. 3 17 The incidence of LNM is the most important prognostic factor for recurrence, metastasis, and survival in these patients. Criteria for selecting patients who are at significant risk for micrometastases and should undergo inguinal dynamic sentinel lymph node biopsy or lymphadenectomy is still controversial.…”

“…1 2 The presence and extent of inguinal lymph node metastases (ILNM) are the most important determinants of survival in patients with PSCC. 3 4 At present, the selection of patients who are at significant risk for micrometastasis and should undergo “therapeutic” lymphadenectomy continues to be of paramount importance. 5 6 Multiple clinicopathological factors of the primary penile tumor, such as clinical lymph node stage, tumor grade, histologic grade, growth pattern, and both lymphatic and vascular embolization have been evaluated as significant predictors of ILNM in previous studies.…”

“… 5 6 Multiple clinicopathological factors of the primary penile tumor, such as clinical lymph node stage, tumor grade, histologic grade, growth pattern, and both lymphatic and vascular embolization have been evaluated as significant predictors of ILNM in previous studies. 3 7 8 The World Health Organization (WHO) classifies PSCC as common, basaloid, verrucous, warty, papillary, sarcomatoid, adenosquamous, mixed, and other rarer histologic subtypes according to their patterns of growth and histological features. 9 …”

Survival Analysis of Primary Tumor Staging (T), Lymph Node Status (N), Tumor Grading, Cell Subtype, Lymphovascular Invasion Status, and Preoperative Neutrophil-Lymphocyte Ratio Values in Penile Cancer

“…Ngoerah Hospital in Denpasar itself recorded 65 patients diagnosed with penile cancer for 5 years (2011)(2012)(2013)(2014)(2015), with an average patient age of 53.24 ± 13.42 years. [4] However, in developing countries with good health and religious systems and embracing the importance of circumcision for health, the incidence rate of malignancy of the penis is 0.1 per 100,000. [5] There are several risk factors for penile cancer, such as phimosis, penile hygiene standards, number of sexual partners, HPV virus infection, exposure to tobacco products, and inflammatory processes such as Lichen Sclerosus, Balanitis Xerotica Obliterans, and Carcinoma In Situ.…”