Identification of Prognostic Pathologic Parameters in Squamous Cell Carcinoma of the Penis

Cubilla, Antonio L.; Velázquez, Elsa F.; Ayala, Gustavo; Chaux, Alcides; Torres, José; Reuter, Victor E.

doi:10.1097/01.pcr.0000153239.13371.58

Cited by 17 publications

(11 citation statements)

References 35 publications

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“…Johnson reached a similar conclusion in a study of 153 cases (22). On the other hand, Ornellas and Cubillas found histological grade to be a significant adverse prognostic factor for lymph nodes metastasis and survival (16,23).…”

Section: Discussionsupporting

confidence: 51%

“…The average number of inguinal lymph nodes was 9.7 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Among the 4 patients who underwent pelvic lymphadenectomy, the average number of lymph nodes removed was 11.7 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Resultsmentioning

confidence: 99%

“…Cubilla (16) and Ornellas (23) demonstrated that vascular invasion is a more important predictor of metastasis than perineural invasion. In our study, perineural invasion was observed in 11 patients (68.7%), three (27.3%) of whom are currently alive.…”

Section: Discussionmentioning

confidence: 99%

“…Tumors were graded with the most commonly used classifi cation system: grade I = well differentiated; grade II = moderately differentiated, and grade III = poorly differentiated (16).…”

Section: Methodsmentioning

confidence: 99%

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Locally advanced penile carcinoma: classic emasculation or testis-sparing surgery?

Gonzaga-Silva¹,

Lima²,

Tavares³

et al. 2012

Int. braz j urol.

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Purpose:The study evaluates the clinical and pathological fi ndings of 16 patients with locally advanced penile carcinoma (PC) submitted to emasculation, and discusses questions related to the usefulness of bilateral orchiectomy. Materials and Methods: Between 1999 and 2010, 172 patients with PC were treated. Sixteen (9%) underwent emasculation. Data were retrieved from the institution's database including age, ethnicity, date of surgery, residential setting, level of schooling, time to diagnosis, type of reconstruction, complications, tumor stage and grade, vascular and perineural invasion along with invasion of corpus cavernosum, corpus spongiosum, testicles, scrotum and urethra. Results: A total of 16 patients (average: 63.1 years) with locally advanced PC were included. All were illiterate or semiliterate rural dwellers and 87% were white. The time to diagnosis was 8-12 months. The mean follow-up time was 31.9 months (1-119). By the time of the last follow-up, only seven patients (43.75%) were alive. Tumors were pT4 (n = 6), pT3 (n = 8), pT2 (n = 2), Grade I (n = 5) and Grade II (n = 11). The histopathological examination revealed invasion of the urethra (n = 13), scrotum (n = 5) and testicles (n = 1). The surgical margin was positive in one patient. Six patients (37.5%) had vascular invasion and 11 (68.7%) had perineural invasion. Currently, only one of the former is alive. Conclusions: The fi nding of focal microscopic testicular infi ltration in only one of 32 testicles, even in the presence of clinically apparent scrotal invasion, suggests that emasculation without bilateral orchiectomy is a safe treatment option for patients with locally advanced PC.

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Section: Discussionsupporting

confidence: 51%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Tumors were graded with the most commonly used classifi cation system: grade I = well differentiated; grade II = moderately differentiated, and grade III = poorly differentiated (16).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Locally advanced penile carcinoma: classic emasculation or testis-sparing surgery?

Gonzaga-Silva¹,

Lima²,

Tavares³

et al. 2012

Int. braz j urol.

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“…4,5,7 In penile cancer, however, it has been consistently reported as a significant prognostic pathologic factor 1,18,14,19,21,24,40,45 but a clear description of morphologic criteria is often lacking. We recently reported a simpler system, the one used in this report, where grades 1 and 3 (well and poorly differentiated tumors) represent extremes of differentiation, from grade 1, simulating normal penile epithelial squamous tissues, to cellular anaplasia for grade 3.…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Index

Chaux

Caballero

Soares

et al. 2009

American Journal of Surgical Pathology

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A concern of surgical oncologists has been to find a method to select patients for groin dissection in penile carcinomas considering the high morbidity of this procedure. A promising methodology, in the identification of early metastatic foci by the sentinel lymph node technique (initiated in Paraguay in the 1970s), was found, using a static anatomic approach, to be associated with a recurrence rate of 30%. Later, a dynamic method using radioactive tracers and peritumoral dye injection was introduced with an improvement in patients' outcome. Recurrences, however, remained high in most studies at a rate of about 15% to 20% except in few highly specialized centers with failure rates of 5%. The technical sophistication, lack of multicenter reproduction, and cost of dynamic sentinel node biopsies preclude their routine implementation in developing countries and other approaches are necessary. Because histologic grade, depth of tumor infiltration, and perineural invasion (PNI) are considered among the most important pathologic prognostic parameters in penile cancer, we devised a Prognostic Index combining these 3 factors. In this study, we are evaluating the incidence of nodal metastasis according to the Prognostic Index score. Pathologic materials from 193 patients with penectomy/circumcision and bilateral groin dissections for invasive squamous cell carcinoma were analyzed. The Prognostic Index (ranging from 2 to 7) consisted in the addition of numerical values given to histologic grade (1 to 3), deepest anatomic level involved by cancer (1 to 3), and presence of PNI (0 or 1). Histologic grades were defined as follows: grade 1, carcinomas with minimal to no atypias; grade 3, tumors showing any proportion of anaplastic cells; and grade 2, the remainder tumors. The anatomic levels and their numerical values were: in glans, lamina propria, 1; corpus spongiosum, 2; and corpus cavernosum, 3. In foreskin they were: lamina propria, 1; dartos, 2; and skin, 3. PNI was evaluated as follows: absence of PNI, 0; presence of PNI, 1. Penile intraepithelial neoplasia (carcinoma in situ), or index 1, was excluded from the study. Mean follow-up obtained in all patients was of 81 months. The distribution of cases and rate of metastasis according to index scores were: 2 (1 case), no metastasis; 3 (17 cases), no metastasis; 4 (35 cases), 20% of metastasis; 5 50 cases), 50% of metastasis; 6 (47 cases), 66% of metastasis; and 7 (43 cases), 79% of metastasis. On logistic regression analysis evaluating various pathologic factors, Prognostic Index scores were found as the best predictors of inguinal node metastasis and patients' survival. Inguinal node dissections might not be necessary for patients with low indices (2 and 3). Nodal dissections might be formally indicated for high-grade indexes (5 to 7). Patients with index 4 should be individually assessed for nodal dissection. If sentinel node biopsy cannot be performed for various reasons the Prognostic Index might represent a useful pathologic guide to the clinicians in the often difficu...

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