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Predictors of Pelvic Lymph Nodal Metastasis in Penile Squamous Cell Carcinoma- Results from a Matched-Pair Analysis

Published:November 17, 2022DOI:https://doi.org/10.1016/j.clgc.2022.11.008

      CLINICAL PRACTICE POINTS

      • Variable like extranodal extension, number, and laterality of inguinal nodes involved are known predictors of pelvic lymph node metastasis in penile squamous cell carcinoma
      • These predictors, however, are largely established on data from the western world with a relatively lower incidence of penile cancer
      • On the other hand number of the positive inguinal nodes appear to be the most important predictor in our setup.
      • A higher threshold of metastatic inguinal lymph nodes for addressing pelvic lymph node dissection can be further investigated, particularly in a high disease burden setup.

      ABSTRACT

      Introduction

      In penile squamous cell carcinoma (SCC), pelvic lymph nodes (PLN) metastasis has a dismal prognosis compared to disease limited to inguinal lymph nodes (ILN). In this study, we sought to determine the predictors of PLN metastasis in penile SCC.

      Materials and Methods

      This was a retrospective study including primary penile resections with ILN and PLN dissections over 10 years (2007-2017). A subset of treatment naïve cases with the presence of PLN metastasis was matched for age and tumor size with another subset of cases having metastatic ILN and negative PLN. The variables were correlated with the PLN metastasis using the Chi-square, Fischer exact, and binomial logistic regression tests. Internal validation of the multivariate model was conducted by bootstrapping technique using the same cohort and 2000 bootstraps. The optimum cut-off for the number of positive ILN was obtained by plotting a receiver operating characteristic curve and using the highest Youden's index as a discriminator.

      Results

      A total of 56 cases (28 in each subset) formed the study cohort. On unadjusted analysis the size of the largest ILN (p=0.038), number of positive ILN (p=0.001), percentage of positive ILN (p=0.001), and laterality of ILN involvement (p=0.007) had a significant correlation with PLN metastasis. On adjusted analysis, the number of positive ILN (p=0.011) was the only variable to have statistical significance with the PLN metastasis. Bootstrapping results indicated that this multivariate model represented the dataset adequately. The maximum Youden's index was obtained when ≥5 ILN were positive.

      Conclusions

      To conclude, the number of metastatic ILN is the most important predictor of PLN metastasis. A higher threshold of metastatic ILN for addressing PLN dissection can be investigated, particularly in a high disease burden setup.

      MICROABSTRACT

      The known predictors of pelvic lymph node metastasis in penile squamous cell carcinoma have been established on the data from the western world with a relatively lower incidence of penile cancer. In this study, we sought to determine the predictors of pelvic lymph node metastasis in a setup with a higher incidence of penile cancer.

      Keywords

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