Contemporary Incidence and Predictors of Occult Inguinal Lymph Node Metastases in Men With Clinically Node-negative (cN0) Penile Cancer

Unadkat, Pooja; Fleishman, Aaron; Olumi, Aria F.; Wagner, Andrew A.; Chang, Peter; Kim, Simon P.; Korets, Ruslan; Gershman, Boris

doi:10.1016/j.urology.2021.02.019

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…Inconsistency between the clinical and pathological stage of ILNs inevitably misleads the judgement of regional LN status. Approximately 24% of occult ILN metastases were detected in men with cN0 penile cancer [15]. Early excision of clinically occult ILN metastases led to the improvement in 3-year cancer-specific survival from 35% to 84% when compared with delayed excision [16].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of indocyanine green fluorescence‐guided inguinal lymph node dissection for penile cancer: a randomised trial

Yuan,

Xie,

et al. 2023

BJU International

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ObjectivesTo investigate the safety and efficacy of indocyanine green (ICG) fluorescence‐guided inguinal lymph node dissection (ILND) in patients with penile cancer.Patients and MethodsA prospective, single‐blind, randomised controlled clinical trial (ChiCTR2100044584) was performed among patients with penile caner who underwent bilateral modified ILND at four centres in China between 1 April 2021 and 30 June 2022. Patients aged 18–80 years and diagnosed with squamous cell carcinomas were included. Each enrolled patient was randomly assigned to either ICG fluorescence‐guided ILND by a laparoscopic or robot‐assisted approach in one groin, with non‐ICG fluorescence‐guided ILND in the other groin acting as a control. The primary outcome was the number of retrieved ILNs. Secondary outcomes included complications according to the Clavien–Dindo classification and the ILN non‐compliance (inadequate removal of ILNs) rate.ResultsA total of 45 patients were included in the intention‐to‐treat (ITT) analysis, and the 42 who completed the entire study were included in the per protocol (PP) analysis. There were no ICG‐related complications in any of the patients. The results of the ITT and PP analyses indicated that the total number of unilateral ILNs retrieved was higher on the ICG side than on the non‐ICG side (mean 13 vs 9 ILNs, difference 4 ILNs [95% CI 2.7–4.4], P = 0.007), and the number of unilateral deep and superficial ILNs was higher on the ICG side. Furthermore, the LN non‐compliance rate was lower on the ICG side than on the non‐ICG side. Additionally, there was no significant difference in local complications in the groins between the two sides (P > 0.05).ConclusionAn ICG fluorescence‐guided ILND was safe for patients with penile cancer. This procedure can improve the number of ILNs retrieved and reduce the LN non‐compliance rate without increased complications. ICG fluorescence‐guided ILND is beneficial and recommended for selected patients with penile cancer.

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Section: Discussionmentioning

confidence: 99%

Efficacy of indocyanine green fluorescence‐guided inguinal lymph node dissection for penile cancer: a randomised trial

Yuan,

Xie,

et al. 2023

BJU International

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“…However, clinician experience and patient body habitus can limit the detection of metastasis. Contemporary analysis has identified that 23% of men with clinically impalpable groins (cN0) harbour occult disease [7]. Controversy exists regarding the pathological staging of pSCC lymphadenopathy (Table 2).…”

Section: Diagnosismentioning

confidence: 99%

“…Prognosis declines precipitously in men with metastatic disease [4]. However, due to a lack of awareness and psychosocial barriers, 20-40% of men present with malignant lymphadenopathy [5][6][7]. Effective management requires timely, aggressive and stage-specific treatment.…”

Section: Introductionmentioning

confidence: 99%

Recent developments in the diagnosis and management of N1 penile cancer

O’Brien

McVey

Kelly

et al. 2022

Current Opinion in Urology

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Purpose of review This article presents a critical review of the current literature to provide a brief update on the contemporary advances in diagnosing and managing N1 penile cancer. Recent findings Penile squamous cell carcinoma (pSCC) has evolved from being an orphan field for cancer innovation. Advances in the understanding tumour biology have enabled sophisticated diagnostics and predictive modelling to better characterize inguinal disease. Minimally invasive inguinal lymph node dissection is emerging as a technique that reduces morbidity while maintaining oncological safety. Furthermore, robust clinical trials are underway ,which will provide level one evidence to guide treatment decisions. Exciting advances in the field of immune-oncology offer promise as adjuvant therapies. International collaboration and centralisation of care will be essential to driving translational research and equitable evidence-based care. Summary Improving outcomes for men with pSCC remains a global challenge. Radical inguinal lymph node dissection remains the gold standard for diagnosing and curing N1 disease. Although many promising developments are on the horizon, high-level evidence is required to guide therapy.

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