Lymph Node Dissections for T3T4 Stage Penile Cancer Patients Without Preoperatively Detectable Lymph Node Metastasis Bring More Survival Benefits: A Propensity Matching Analysis

Abstract

Background and AimsThe current guidelines for the treatment of penile cancer patients with clinically non-invasive normal inguinal lymph nodes are still broad, so the purpose of this study is to determine which patients are suitable for lymph node dissection (LND).MethodsHistologically confirmed penile cancer patients (primary site labeled as C60.9-Penis) from 2004 to 2016 in the Surveillance, Epidemiology, and Results database were included in this analysis. Univariate and multivariate Cox regression analyses were applied to determine an overall estimate of LND on overall survival and cancer-specific survival. A 1:1 propensity matching analysis (PSM) was applied to enroll balanced baseline cohort, and further Kaplan–Meier (KM) survival analysis was used to get more reliable results.ResultsOut of 4,458 histologically confirmed penile cancer patients with complete follow-up information, 1,052 patients were finally enrolled in this analysis. Age, pathological grade, T stage, and LND were identified as significant predictors for overall survival (OS) in the univariate Cox analysis. In the multivariate Cox regression, age, pathological grade, T stage, and LND were found significant. The same results were also found in the univariate and multivariate Cox regression analyses for cancer-specific survival (CSS). After the successful PSM, further KM analysis revealed that LND could bring significant OS and CSS benefits for T3T4 patients without lymph node metastasis.ConclusionLymph node dissection may bring survival benefits for penile cancer patients without preoperatively detectable lymph node metastasis, especially for T3T4 stage patients. Further randomized control trial is needed.

Survival Analysis of Primary Tumor Staging (T), Lymph Node Status (N), Tumor Grading, Cell Subtype, Lymphovascular Invasion Status, and Preoperative Neutrophil-Lymphocyte Ratio Values in Penile Cancer

“…[24] This was related to the status of lymph nodes in penile cancer, which is a significant predictor of survival, so inguinal lymph node dissection, which is local control and chemotherapy as a systemic control, can increase the duration of survival of penile cancer patients. [23,25,26] In addition, this study also found that patients who received total penectomy surgery had a longer average survival compared to those who underwent partial penectomy or did not have surgery, but this result was not statistically significant. This is different from a study conducted by Kamel et al (2018) which found that patients with partial penectomy had better 3-year survival compared to total penectomy (83% vs 76% respectively), with HR 0.82 (CI95% 0, 64-1.04) but not statistically significant.…”