Lymph node metastases and prognosis in penile cancer

Abstract

Lymph node status is a key prognostic factor in penile squamous cell carcinoma. Recently, growing evidence indicates a multimodality approach consisting of neoadjuvant chemotherapy followed by consolidation surgery improves the outcome of locally advanced penile cancer. Thus, accurate estimation of survival probability in node-positive penile cancer is critical for treatment decision making, counseling of patients and follow-up scheduling. This article reviewed evolving developments in assessing the risk for cancer progression based on lymph node related variables, such as the number of metastatic lymph nodes, bilateral lymph node metastases, the ratio of positive lymph nodes, extracapsular extension of metastatic lymph nodes, pelvic lymph node metastases, metastatic deposit in sentinel lymph nodes and N stage in TNM classification. Controversial issues surrounding the prognostic value of these nodal related predictors were also discussed.

Surgical treatment of advanced penile cancer

“…Among our 12 patients, 6 with N3 stage disease died with a 7.4-month survival on average. Their prognosis was poor, consistent with a previous report in the literature (Zhu and Ye 2012 ).…”

“…Patients with 1–3, 4 or 5, or >5 lymph nodes involved have a 75.6, 8.4, or 0% 5-year survival rate, respectively. According to Yao Zhu et al ( 2012 ), unilateral and bilateral lymph node metastases have 3-year recurrence-free survival rates of 59.2 and 26.7%, respectively. Much evidence has proven that the ratio of positive lymph nodes have more advantage than number-based nodal staging in predicting cancer prognosis (Vinh-Hung et al 2009a , b ; Berger et al 2005 ).…”

“…Similar findings were reported by Ravi ( 1993 ). According to Zhu et al ( 2012 ), patients with sentinel lymph nodes of <2 and >2 mm in size had disease-specific survival rates of 94.4 and 69.5%, respectively. The size of the sentinel lymph node can predict additional lymph node metastasis, but this needs further study.…”

“…We should perform radical surgery for patients with partial advanced PC without clear metastasis if their physical conditions permit. For the seventh N category, the 3-year recurrence-free survival rates of N1, N2, and N3 were 87.5% ( n = 16), 57% ( n = 22), and 31.8% ( n = 22), respectively (Zhu and Ye 2012 ). According to Liu et al ( 2013 ), patients with T0-3N0-2M0 disease have an overall survival of >14 months, and the longest surviving patient is still alive up to now.…”

Prognostic Nomogram for Penile Cancer, an Analysis Based on SEER Database

“…But it seemed to be not signi cant among some subgroups, including stage T1a, stage T1b and stage T1NOS. Similar to most studies, lymph node involvement and distant metastasis remained independent risk factors for patients' prognosis [28].…”