The risk factors for the presence of pelvic lymph node metastasis in penile squamous cell carcinoma patients with inguinal lymph node dissection

Abstract

Primary tumor expression of p53, lymphatic or vascular invasion, number of metastatic inguinal lymph nodes and lymph node density were all predictors of pathologic pelvic lymph node involvement. Patients with pelvic LNM had an adverse prognosis, with a 3-year overall survival rate of approximately 12.1%. Pelvic lymph node dissection should be considered in these cases.

Lymph node density predicts recurrence and death after inguinal lymph node dissection for penile cancer

“…Nodal burden, represented as number of positive LN, has been shown to be associated with poorer prognosis [71112]. Pandey et al [2] identified a 75.6%, 8.4%, and 0% 5-year survival with patients who had 1–3, 4–5, and >5 nodes, respectively.…”

“…Therefore, considerable interest has focused on the inguinal lymph node dissection (ILND) which provides valuable pathologic staging [567], guides adjuvant therapy [8], and offers therapeutic benefit [9]. Multiple studies, as reflected in current TNM staging for penile cancer [10], have shown that number of positive lymph node (LN) predicts recurrence-free survival (RFS) and overall survival (OS) [71112]. However, these studies do not account for the extent of ILND, masking the true extent of lymph node involvement.…”

Extent of pelvic lymph node dissection in penile cancer may impact survival

“…All patients had squamous cell carcinoma of the penis with unilateral inguinal LNM and pathological confirmation of pelvic nodes following PLND. The decision to perform PLND has changed over time in each contributing center, however, currently is based on the presence of two or more inguinal LNM, the presence of extranodal extension (ENE) or suspicious pelvic imaging [5,6,10]. The extent of the PLND was not standardized between the centers; however, it included external iliac, obturator and internal iliac nodes.…”

Current surgical management of penile cancer

“…58 The boundaries of PLND include the iliac bifurcation proximally, ilioinguinal nerve laterally, and the obturator nerve medially. PLND involves removal of the obturator, internal iliac, and external iliac LNs as well as any clinically positive LNs in the pelvis.…”