Tumor Stage, Vascular Invasion and the Percentage of Poorly Differentiated Cancer: Independent Prognosticators for Inguinal Lymph Node Metastasis in Penile Squamous Cancer

Slaton, Joel W.; Morgenstern, Nora; Levy, David A.; Santos, Misael Wanderley; Tamboli, Pheroze; Ro, Jae Y.; Ayala, Alberto G.; Pettaway, Curtis A.

doi:10.1097/00005392-200104000-00018

Cited by 16 publications

(14 citation statements)

References 27 publications

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“…Another limitation of the proposed classification is the negligence of the grading. 9 It has been reported that the incidence of lymph node metastasis in T1 cases combined with a G2 grade is high, reaching 50%. 10 Other well-known prognostic elements, such as the vascular invasion 9 and the growth pattern (superficial vs vertical), 11 have also been neglected in the proposed modifications.…”

Section: Discussionmentioning

confidence: 99%

External validation of the proposed T and N categories of squamous cell carcinoma of the penis

Al-Najar¹,

Alkatout

Al-Sanabani³

et al. 2011

Int J of Urology

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Objectives:The aim of this study was to validate recently proposed modifications to the current TNM classification of penile squamous cell carcinoma (PSCC) by using data from four German urological centers. Methods: We identified 89 patients treated for histologically confirmed PSCC between 1996 and 2008 and reclassified them according to the proposed TNM staging revisions. The proposed changes restricted T2 to tumoral invasion of the corpus spongiosum, whereas invasion of the corpus cavernosum was considered as T3. No changes were made to T1 and T4. Furthermore, N1 was limited to unilateral and N2 to bilateral inguinal lymph node involvement regardless of their number. Pelvic lymph node involvement and fixed lymph node were considered as N3 tumors. The range of follow up after initial treatment was 1-142 months (mean 38). Results: Node-negative cases following the current classification were 65.2% (30/46), 48.5% (16/33) and 87.5% (7/8) for T1, T2 and T3, respectively. According to the proposed classification, N0 cases were markedly reduced in the T3 group (55.5%, 10/18) and relatively changed in the T2 group (56.5%, 13/23). T4 patients had no negative disease status. The 3-year disease-specific survival (DSS) rates for the proposed categories were 85.4%, 71.6% and 62.4% for T1, T2 and T3, respectively. For the current categories, the 3-year DSS rates were 85.4%, 66.9% and 100% for T1, T2 and T3, respectively. The 3-year DSS of the current N categories was 78.7%, 51% and 13.3% for N1, N2 and N3, respectively. According to the newly proposed categories, the 3-year DSS was 70%, 50% and 13.3% for N1, N2 and N3, respectively. Conclusion: Tumor and nodal staging of the newly proposed TNM classification show a more distinctive survival compared to the current one. However, a multi-institutional validation is still required to further corroborate the proposed modifications.

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Section: Discussionmentioning

confidence: 99%

External validation of the proposed T and N categories of squamous cell carcinoma of the penis

Al-Najar¹,

Alkatout

Al-Sanabani³

et al. 2011

Int J of Urology

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“…Grading of penile cancer is based on cellular anaplasia where grade 1 is well differentiated, grade 2 is moderately differentiated and grade 3 is poorly differentiated [ 60 ] Staging is a continuous developing process that improves standardisation of information about a treatment process and prognostication. Recently, the American Joint Committee on Cancer (AJCC) updated their staging system for penile cancer [ 61 ] .…”

Section: Grading/stagingmentioning

confidence: 99%

Contemporary diagnosis and management of squamous cell carcinoma (SCC) of the penis

et al. 2011

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What's known on the subject? and What does the study add? Penile cancer is a rare malignancy with limited evidence to support most treatment recommendations. No randomised controlled trials have been published and few recommendations are available for guiding management. However, evidence‐based guidelines are currently available through the European Association of Urology. This review provides the reader with the most up‐to‐date information on diagnosis and management of all stages of squamous cell carcinoma of the penis. It provides a rapid review and study guide for this rare disease. To review the current literature available on squamous cell carcinoma (SCC) of the penis and provide a contemporary management algorithm for treatment based on the best evidence available. A complete review of the current English language literature was performed via PubMed and all available guidelines were reviewed. Large randomised controlled trials are lacking in penile SCC due to the fortunately rare occurrence of the disease. Treatment recommendations for the primary lesion, lymph nodes, and follow‐up in this review are based on the best current available literature. Early diagnosis and aggressive organ‐sparing treatment remains the mainstay of therapy for penile SCC. Variable institutional expertise currently makes treatment decisions difficult and unstandardised. A multidisciplinary approach should be used in attempt to improve outcomes in this mutilating disease.

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“…1,[54][55][56] Unlike patients with superficially invasive (2 cm or less) or well-differentiated tumors, 57 patients with high-grade neoplasms showing extensive penile shaft involvement and a flat growth pattern are at greater risk for inguinal lymph node involvement. 1,58,59 Treatment Treatment for invasive carcinomas of the penis is, in most cases, surgical ablation. A suspicious penile lesion should always be biopsied first for histopathologic evaluation, and if small enough, an excisional biopsy should be advisable, as this may provide a No evidence of regional node involvement N1…”

Section: Diagnosis/stagingmentioning

confidence: 99%

“…75 Watchful waiting may be advised in patients with no inguinal node enlargement and superficially invasive and low-grade SCCs. 58,59 Alternatively, bilateral sentinel lymph node mapping and biopsy may be recommended, especially for patients with T2 or poorly differentiated node-negative disease to identify those that may benefit from regional node dissection. 55,56,77 However, regional recurrence after excision of a negative sentinel node has been observed in 22% of the patients.…”

Section: Diagnosis/stagingmentioning

confidence: 99%

Invasive Penile Carcinoma: A Review

Micali¹,

Nasca²,

Innocenzi³

et al. 2004

Dermatol Surg

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Although there are no current guidelines for the treatment of penile carcinoma, surgical ablation probably represents the best option, as conservative treatments still deserve cautious evaluation because of the relatively small number of treated patients and the lack of good-quality comparative data. Regarding indications for lymph nodal dissection in patients showing no inguinal node enlargement, sentinel node mapping with targeted lymph node dissection is recommended for those with deeply invasive, high-grade tumors, whereas a watchful waiting may be advised for those with superficially invasive, low-grade tumors.

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Tumor Stage, Vascular Invasion and the Percentage of Poorly Differentiated Cancer: Independent Prognosticators for Inguinal Lymph Node Metastasis in Penile Squamous Cancer

Cited by 16 publications

References 27 publications

External validation of the proposed T and N categories of squamous cell carcinoma of the penis

External validation of the proposed T and N categories of squamous cell carcinoma of the penis

Contemporary diagnosis and management of squamous cell carcinoma (SCC) of the penis

Invasive Penile Carcinoma: A Review

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