Elevated C-reactive protein values predict nodal metastasis in patients with penile cancer

Abstract

BackgroundThe nodal status is a strong predictor for cancer specific death in patients with penile carcinoma, and the C-reactive protein (CRP) level at diagnosis has recently been shown to be associated with poor clinical outcome in various solid malignancies. Therefore, this retrospective study was performed to evaluate the association between preoperative CRP levels and the incidence of nodal metastasis in patients with squamous cell carcinoma (SCC) of the penis.MethodsThe analysis included 51 penile cancer patients who underwent either radical or partial penectomy for pT1-4 penile cancer between 1990 and 2010. The nodal status was correlated with patient and tumor specific characteristics.ResultsSixteen (31%) patients had lymph node metastasis at the time of penile cancer surgery. Nodal status was associated with tumor stage but did not correlate significantly with tumor grade. In contrast, high presurgical CRP levels were significantly associated with the diagnosis of nodal involvement (p = 0.04). The optimal CRP cut-off value to predict lymph node metastasis was set at 20 mg/l based on ROC analysis.ConclusionsSince a high preoperative serum CRP level was closely correlated with nodal disease, it could be used as an additional marker to help identify patients with penile cancer who may benefit from inguinal lymph node dissection.

The role of histologic subtype, p16INK4a expression, and presence of human papillomavirus DNA in penile squamous cell carcinoma

“…Furthermore, we detected no significant differences in cancer-specific survival with regard to histologic differentiation grade, or p16 INK4a positivity. This is in line with some previous studies that failed to confirm a proposed association between histopathologic grade and lymph node metastasis or overall survival in pSCC, while it has to be stated as a clear limitation of our study that follow-up data was only obtainable for 35 patients (60.3%) [ 38 - 40 ]. Considering the substantial interobserver variability that has been described for histopathologic grading in pSCC (between 59-87% with ĸ = 0.38-0.69 [ 41 ]), we think that the current histopathologic grading is of limited value due to an obvious lack of prognostic relevance; this conclusion is also supported by other authors [ 42 ].…”

Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Penile Squamous Cell Carcinoma Patients Undergoing Inguinal Lymph Node Dissection

“…Several additional markers of systemic inflammation such as C-reactive protein (CRP), platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio were suggested as potential prognostic factors in other solid malignancies Table 2 -Multivariable Cox regression models predicting overall survival, cancer-specific survival, and recurrence-free survival of penile cancer patients treated with inguinal lymph node dissection. [20][21][22][23]. One study found that a high preoperative serum CRP (>15 mg/l) was an independent predictor of worse CSS in 48 node-negative men with PSCC [24].…”

Serum biomarkers to predict risk of testicular and penile cancer in AMORIS

“…None of the studies have considered systemic markers of inflammation and carcinogenesis. Most of the studies investigating serological biomarkers in context of penile [ 10 , 11 ] and testicular cancers [ 8 , 22 – 24 ] have investigated on disease diagnosis, progression, treatment response, and late side effects with little focus on risks.…”

“…A German study based on 79 cases found that high pre-operative levels of serum CRP were associated with poor survival [ 10 ]. In a retrospective study, high pre-surgical CRP levels were significantly associated with lymph nodal involvement and poor outcomes [ 11 ].…”