CC BY-NC-ND 4.0 · Revista Urología Colombiana / Colombian Urology Journal 2020; 29(02): 084-090
DOI: 10.1055/s-0039-1697997
Original Article | Artículo Original
Urologic Oncology/Urología Oncológica
Sociedad Colombiana de Urología. Publicado por Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Prognostic Factors for Inguinal Lymph Node Involvement and Tumor Recurrence in Squamous Cell Carcinoma of the Penis

Factores pronósticos de compromiso ganglionar inguinal y recaída tumoral en carcinoma escamocelular de pene
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Angie Ramírez
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Rodolfo Varela
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Daniela Robledo
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
José De la Hoz-Valle
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Rafael Vargas
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Jorge Forero
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Fabián Godoy
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Marino Cabrera
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Claudia Ochoa
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Byron López
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Wilfredo Donoso
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Sergio Giraldo
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Carolina Pinzón
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Sara Peralta
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
,
Andrés Calderón
1   Department of Oncological Urology, Instituto Nacional de Cancerología, Bogotá, Colombia
› Author Affiliations
Further Information

Publication History

10 March 2019

26 July 2019

Publication Date:
06 April 2020 (online)

Abstract

Introduction Penile carcinoma is an aggressive disease with catastrophic consequences that frequently lead to death. Therefore, further knowledge on the prognostic factors that can help identify patients in need of more aggressive treatments becomes essential.

Objective To identify the prognostic factors for lymph node (LN) involvement and tumor recurrence in patients diagnosed with squamous cell carcinoma of the penis (SCCP).

Methods A retrospective cohort study was conducted. Patients diagnosed and treated for SCCP at Instituto Nacional de Cancerología between 2008 and 2015 were included in the sample. Cases in which no information on recurrence was available for the follow-up were excluded, as well as patients with no initial pathology and those getting penile reconstructions after cancer.

Relevant data was retrieved from the medical records of each patient, and a descriptive analysis was performed. Subsequently, this data was used to apply a logistic regression model to determine the potential clinical and histopathological prognostic factors.

Results A total of 104 patients were included in the present study. The average age of the sample was 59 years, while the follow-up averaged 24 months per patient. Inguinal lymphadenectomy was performed on 61 patients (59%) during the follow-up. The logistic regression model showed that lymphovascular invasion (odds ratio [OR]: 6.7; 95% confidence interval [95%CI]: 1.2–35) and poor tumor differentiation (OR: 17; 95%CI: 3.2–92) were associated with tumor recurrence. Likewise, the lymphadenectomy procedures showed that lymphovascular invasion was associated with LN involvement (OR: 3.3; 95%CI: 1.1–10).

Conclusion Lymphovascular invasion was the strongest prognostic factor observed in our sample, aiding in the prediction of inguinal LN involvement and tumor recurrence in SCCP patients.

Patient Summary

Lymphovascular invasion should be the main factor to determine the management and follow-up of SCCP patients.

Resumen

Introduccion El cáncer de pene es una enfermedad agresiva con consecuencias catastróficas que frecuentemente llevan a la muerte. Por lo tanto, es esencial un mayor conocimiento sobre los factores pronósticos que pueden ayudar a identificar a los pacientes que necesitan tratamientos más agresivos.

Objetivo Identificar los factores pronósticos patológicos de compromiso ganglionar inguinal y recaída tumoral en pacientes con carcinoma escamocelular de pene.

Métodos Se realizó un estudio de cohorte retrospectivo. Se incluyeron en la muestra pacientes diagnosticados y tratados por carcinoma escamocelular de pene (SCCP) en el Instituto Nacional de Cancerología entre 2008 y 2015. Los casos en los que no había información sobre la recurrencia en el seguimiento fueron excluidos, así como los pacientes sin patología inicial y aquellos que reciben reconstrucciones del pene después del cáncer. Se recuperaron los datos relevantes de los registros médicos de cada paciente, y una descripción fue realizada. Posteriormente, estos datos se utilizaron para aplicar un modelo de regresión logística para determinar los posibles factores pronósticos clínicos e histopatológicos.

Resultados Un total de 104 pacientes fueron incluidos en el estudio. La edad promedio de la muestra fue de 59 años, mientras que el seguimiento promedió fue de 24 meses por paciente. La linfadenectomía inguinal se realizó en 61 pacientes (59%) durante el seguimiento. El modelo de regresión logística mostró que la invasión linfovascular (odds ratio [OR]: 6,7; intervalo de confianza del 95% [IC 95%]: 1,2–35) y la pobre diferenciación tumoral (OR: 17; IC 95%: 3,2–92) se asociaron con recurrencia tumoral. Así mismo, los procedimientos de linfadenectomía mostraron que la invasión linfovascular se asoció con afectación de LN. (OR: 3,3; IC 95%: 1,1-10).

Conclusión La invasión linfovascular es el factor pronóstico independiente más importante que se asocia de manera independiente con compromiso ganglionar inguinal positivo y recaída tumoral.

 
  • References

  • 1 Barocas DA, Chang SS. Penile cancer: clinical presentation, diagnosis, and staging. Urol Clin North Am 2010; 37 (03) 343-352
  • 2 Cataño JGC, Niño JFP, Schlessinger AA. Manejo actual del cáncer de pene en el Hospital Universitario de San Ignacio. Revista Urol Colomb. 2010; 19 (01) 1
  • 3 Beech B, Izawa J, Pautler S, Chin J, Power N. Penile cancer: Perspective from a Canadian tertiary care centre. Can Urol Assoc J 2015; 9 (9-10): 315-319
  • 4 Hernandez BY, Barnholtz-Sloan J, German RR. , et al. Burden of invasive squamous cell carcinoma of the penis in the United States, 1998-2003. Cancer 2008; 113 (10, Suppl): 2883-2891
  • 5 Pow-Sang MR, Ferreira U, Pow-Sang JM, Nardi AC, Destefano V. Epidemiology and natural history of penile cancer. Urology 2010; 76 (02) (Suppl. 01) S2-S6
  • 6 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65 (01) 5-29
  • 7 Favorito LA, Nardi AC, Ronalsa M, Zequi SC, Sampaio FJB, Glina S. Epidemiologic study on penile cancer in Brazil. Int Braz J Urol Off J Braz Soc Urol 2008; 34 5: 587-591 ; discussion 591–3
  • 8 Pahwa M, Girotra M, Rautela A, Abrahim R. Penile cancer in India: a clinicoepidemiological study. Gulf J Oncolog 2012; (12) 7-10
  • 9 Chalya PL, Rambau PF, Masalu N, Simbila S. Ten-year surgical experiences with penile cancer at a tertiary care hospital in northwestern Tanzania: a retrospective study of 236 patients. World J Surg Oncol 2015; 13: 71 . cited 2016 Jun 8 [Internet]. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341227/
  • 10 Ramírez G, Bermúdez Puppo AJ. Carcinoma de Pene. Urol Colomb 22: 37-3
  • 11 Narayana AS, Olney LE, Loening SA, Weimar GW, Culp DA. Carcinoma of the penis: analysis of 219 cases. Cancer 1982; 49 (10) 2185-2191
  • 12 Hakenberg OW, Compérat EM, Minhas S, Necchi A, Protzel C, Watkin N. EAU guidelines on penile cancer: 2014 update. Eur Urol 2015; 67 (01) 142-150
  • 13 Clark PE, Spiess PE, Agarwal N. , et al; National Comprehensive Cancer Network. Penile cancer: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2013; 11 (05) 594-615
  • 14 Slaton JW, Morgenstern N, Levy DA. , et al. Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol 2001; 165 (04) 1138-1142
  • 15 Lam W, Alnajjar HM, La-Touche S. , et al. Dynamic sentinel lymph node biopsy in patients with invasive squamous cell carcinoma of the penis: a prospective study of the long-term outcome of 500 inguinal basins assessed at a single institution. Eur Urol 2013; 63 (04) 657-663
  • 16 Leijte JAP, Kroon BK, Valdés Olmos RA, Nieweg OE, Horenblas S. Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol 2007; 52 (01) 170-177
  • 17 Marconnet L, Rigaud J, Bouchot O. Long-term followup of penile carcinoma with high risk for lymph node invasion treated with inguinal lymphadenectomy. J Urol 2010; 183 (06) 2227-2232
  • 18 Lont AP, Kroon BK, Gallee MPW, van Tinteren H, Moonen LMF, Horenblas S. Pelvic lymph node dissection for penile carcinoma: extent of inguinal lymph node involvement as an indicator for pelvic lymph node involvement and survival. J Urol 2007; 177 (03) 947-952 , discussion 952
  • 19 Bouchot O, Rigaud J, Maillet F, Hetet JF, Karam G. Morbidity of inguinal lymphadenectomy for invasive penile carcinoma. Eur Urol 2004; 45 (06) 761-765 , discussion 765–766
  • 20 Yao K, Tu H, Li Y-H. , et al. Modified technique of radical inguinal lymphadenectomy for penile carcinoma: morbidity and outcome. J Urol 2010; 184 (02) 546-552
  • 21 Nelson BA, Cookson MS, Smith Jr JA, Chang SS. Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series. J Urol 2004; 172 (02) 494-497
  • 22 Johnson DE, Lo RK. Management of regional lymph nodes in penile carcinoma. Five-year results following therapeutic groin dissections. Urology 1984; 24 (04) 308-311
  • 23 Fraley EE, Zhang G, Manivel C, Niehans GA. The role of ilioinguinal lymphadenectomy and significance of histological differentiation in treatment of carcinoma of the penis. J Urol 1989; 142 (06) 1478-1482
  • 24 Graafland NM, Lam W, Leijte JAP. , et al. Prognostic factors for occult inguinal lymph node involvement in penile carcinoma and assessment of the high-risk EAU subgroup: a two-institution analysis of 342 clinically node-negative patients. Eur Urol 2010; 58 (05) 742-747
  • 25 Kochhar R, Taylor B, Sangar V. Imaging in primary penile cancer: current status and future directions. Eur Radiol 2010; 20 (01) 36-47
  • 26 Cabanas RM. Anatomy and biopsy of sentinel lymph nodes. Urol Clin North Am 1992; 19 (02) 267-276
  • 27 Solsona E, Iborra I, Rubio J, Casanova JL, Ricós JV, Calabuig C. Prospective validation of the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinically negative inguinal lymph nodes. J Urol 2001; 165 (05) 1506-1509
  • 28 Chaux A, Caballero C, Soares F. , et al. The prognostic index: a useful pathologic guide for prediction of nodal metastases and survival in penile squamous cell carcinoma. Am J Surg Pathol 2009; 33 (07) 1049-1057
  • 29 Bhagat SK, Gopalakrishnan G, Kekre NS. , et al. Factors predicting inguinal node metastasis in squamous cell cancer of penis. World J Urol 2010; 28 (01) 93-98
  • 30 Stewart SB, Leder RA, Inman BA. Imaging tumors of the penis and urethra. Urol Clin North Am 2010; 37 (03) 353-367
  • 31 Ferrándiz-Pulido C, de Torres I, García-Patos V. Carcinoma escamoso de pene. Actas Dermosifiliogr 2012; 103 (06) 478-487
  • 32 Guimarães GC, Cunha IW, Soares FA. , et al. Penile squamous cell carcinoma clinicopathological features, nodal metastasis and outcome in 333 cases. J Urol 2009; 182 (02) 528-534 , discussion 534
  • 33 Cubilla AL, Reuter V, Velazquez E, Piris A, Saito S, Young RH. Histologic classification of penile carcinoma and its relation to outcome in 61 patients with primary resection. Int J Surg Pathol 2001; 9 (02) 111-120
  • 34 Ficarra V, Akduman B, Bouchot O, Palou J, Tobias-Machado M. Prognostic factors in penile cancer. Urology 2010; 76 (02) (Suppl. 01) S66-S73