Risk factors and survival outcomes for upstaging after inguinal lymph node dissection for cN1 penile squamous cell carcinoma

Chakiryan, Nicholas H.; Dahmen, Aaron; Bandini, Marco; Pederzoli, Filippo; Marandino, Laura; Albersen, Maarten; Roussel, Eduard; Zhu, Yao; Ye, Dingwei; Ornellas, Antônio Augusto; Catanzaro, Mario; Hakenberg, Oliver W.; Heidenreich, Axel; Haidl, Friederike; Watkin, Nick; Ager, Michael; Briganti, Alberto; Salvioni, Roberto; Montorsi, Francesco; Necchi, Andrea; Spiess, Philippe E.

doi:10.1016/j.urolonc.2021.08.028

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…In the present series we found 26.7% of cN0 patients with positive inguinal nodes after histopathological analysis. In those with palpable nodes, a more intensive preoperative workup may be the key point to identify the high-risk patient in order to offer neoadjuvant (NAC) protocols to avoid upstaging ILDN/VEIL ( 29 ). In this series all NAC cases were excluded due lack of standardized protocols; some cases received taxane and others not, and different time to treat, many received NAC before and others after the penectomy.…”

Section: Discussionmentioning

confidence: 99%

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer

et al. 2023

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Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

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Section: Discussionmentioning

confidence: 99%

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer

et al. 2023

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“…The etiology of PSCC is multifactorial with risk factors such as smoking, chronic inflammation, balanitis, history of phimosis, poor hygiene, socioeconomic status, and human papilloma virus (HPV) infection, particularly types 16 and 18 [ 3 , 5 , 6 ]. Lymph node metastasis (LNM) at initial diagnosis is the most important prognostic marker [ 7 , 8 ]. Therefore, the vital steps for developing treatment strategies in patients with PSCC are the early detection of LNM, appropriate surgical treatment, and neoadjuvant or adjuvant systemic chemotherapy [ 1 , 9 , 10 ].…”

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confidence: 99%

Clinical Lymph Node Involvement as a Predictor for Cancer-Specific Survival in Patients with Penile Squamous Cell Cancer

et al. 2022

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We aimed to identify prognostic predictive factors of patients with penile squamous cell carcinoma (PSCC). This retrospective study reviewed the clinical and pathological data of patients with PSCC at 10 institutions in Japan between January 2008 and December 2019. The primary endpoint was cancer-specific survival (CSS). We also identified useful predictive factors for CSS in patients with PSCC. In total, 64 patients with PSCC were enrolled. At the end of the follow-up period, 15 patients (23.4%) died owing to PSCC and six (9.4%) died owing to other causes. The 2- and 3-year CSS rates were 78.9% and 76.6%, respectively. Using the Kaplan–Meier method, the Eastern Cooperative Oncology Group performance status 0, serum albumin levels ≥4.2 g/dL, hemoglobin levels ≥13.2 g/dL, C-reactive protein levels <0.21 mg/dL, clinical T stage ≤2, clinically negative lymph node (LN) status, and tumor size <30 mm were associated with a significantly better CSS. In the multivariate analysis, the clinically positive LN status was a significant predictive factor for CSS in patients with PSCC. Further prospective large-scale and long-term studies are required to validate our findings.

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“…8 A multimodal approach with administration of neoadjuvant chemotherapy (NAC) followed by consolidative surgery has also demonstrated disease response and suggested there may be a survival benefit for patients with advanced inguinal disease. [9][10][11] As treatment for penile cancer evolves to improve outcomes and decrease morbidity associated with treatment, consideration may be given to concomitant resection of penile tumors and inguinal lymph nodes. However, the effect of ILND performed concurrently at the time of management of the primary lesion on oncologic outcomes in penile squamous cell carcinoma (pSCC) remains highly debated and unclear at this point.…”

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Concomitant vs Staged Therapeutic Inguinal Lymphadenectomy in Clinically Node Positive Penile Squamous Cell Carcinoma: Does It Make a Difference?

et al. 2023

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Purpose:Inguinal lymph node dissection within 3 months of primary tumor resection in penile cancer has been associated with longer recurrence-free and cancer-specific survival. However, the optimal timing and effect of lymphadenectomy performed concurrently at the time of primary lesion management on oncologic outcomes in clinically lymph node positive penile squamous cell carcinoma remains unknown.Materials and Methods:An international, multicenter cohort of 966 penile cancer cases was queried for penile squamous cell carcinoma management after the year 2000, clinically lymph node positive status, and performance of penile surgery and inguinal lymph node dissection. Cohorts were stratified as concomitant if inguinal lymph node dissection and penile surgery occurred on the same date or staged when inguinal lymph node dissection was performed after penile resection. Rates and patterns of penile squamous cell carcinoma recurrence were reported. Distant recurrence-free, cancer-specific, and overall survival were estimated using Kaplan-Meier analyses and groups compared with log-rank testing.Results:Of 253 contemporary men with clinically lymph node positive penile squamous cell carcinoma, 96 (38%) underwent concomitant inguinal lymph node dissection and 157 (62%) had inguinal lymph node dissection performed in a staged manner. Penile cancer was most likely to recur distantly (19%) followed by in the groin (14%) or pelvis (5%). There were no differences in distant recurrence-free, cancer-specific, or overall survival between management strategies. Multivariable analysis adjusting for stage, treatment center, and perioperative chemoradiation also demonstrated no recurrence-free, cancer-specific, or overall survival benefit between management strategies.Conclusions:Inguinal lymph node dissection performed concurrently with excision of the penile tumor for clinically node positive penile squamous cell carcinoma is not associated with differences in recurrence-free, cancer-specific, or overall survival compared to staged lymph node dissection.

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Risk factors and survival outcomes for upstaging after inguinal lymph node dissection for cN1 penile squamous cell carcinoma

Cited by 4 publications

References 19 publications

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer

Clinical Lymph Node Involvement as a Predictor for Cancer-Specific Survival in Patients with Penile Squamous Cell Cancer

Concomitant vs Staged Therapeutic Inguinal Lymphadenectomy in Clinically Node Positive Penile Squamous Cell Carcinoma: Does It Make a Difference?

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