Early Inguinal Lymphadenectomy is Necessary in the Treatment of Penile Cancer T1G2.

Abstract

Backgroud：At present, there is still no consensus on the early inguinal lymph node dissection (eILND) of T1G2 or T1aG2. In this study, we investigated the peculiarities of penile cancer T1G2 and T1aG2 to assess the necessity of eILND for this subgroup.Methods: A total of 144 patients had been treated for penile squamous cell carcinoma with primary tumor excision and early bilateral inguinal lymphadenectomy in my institution from January 2002 to March 2017, thus, 53 patients definitely diagnosed as T1G1 or T1G2 were included in this study. According to the recent guideline, T1aG1 and T1aG2 were even researched. The chi-square test and the Fisher exact test were used to compare categorical variables. Survival were retrospectively analyzed by the Kaplan-Meier method and assessed by log-rank tests. RESULTS: Among 53 patients, the proportion of positive lymph node of T1G2 was 68.8%, which was significantly higher than T1G1 (18.9%, P=0.001). Then we analyzed the patients of clinically node-negative patients (cN0), micro metastatic disease occurred in T1G2 was 50% but in T1G1 was 14.8%, which also reached statistical significance (p=0.043). According to the recent guideline, T1aG1 and T1aG2 had been further analyzed. As the risk for lymphatic spread, T1aG2 was 44.4% while only 4.5% of T1aG1 was found Inguinal lymph node metastasis, significant differences of which were also reached (P=0.017). In an addition, Survival Curve had been demonstrated but no statistical differences found between T1G1 and T1G2, as the same result also existed in the cohort of T1aG1 and T1aG2, all of which revealed a strong proof of therapeutic benefits of eILND.CONCLUSIONS: The option of a surveillance strategy is not applicable to patients of T1G2 or T1aG2, eILND should be highly recommended for this subgroup to achieve the most therapeutic benefits.