What Is New in the Pathologic Staging of Penile Carcinoma in the 8th Edition of AJCC TNM Model: Rationale for Changes With Practical Stage-by-stage Category Diagnostic Considerations

Abstract

For > 50 years the tumor, node, metastasis (TNM) classification model of malignant tumors has been the main resource for clinicians, pathologists, radiologists and public health professionals ensuring a homogeneous classification and patients' management based on common staging and prognosis factors. Penile cancer was first included for staging in the third edition of the TNM classification with several changes in the last version, the 8th edition of the AJCC TNM Manual, in 2017. Some changes in the pT category were done due to recent knowledge regarding the prognostic importance of anatomical level of invasion, vascular and perineural invasion and tumor grading. These changes must be interpreted in the light of a required understanding of the complex anatomy of penile compartments especially their histological boundaries, the morphological differences of each level needed for the correct classification, the heterogeneity of penile squamous cell carcinomas and an adequate criticism of the current model used by the TNM system. We present here a series of stage-by-stage category diagnostic considerations based on the clinical experience acummulated over the years of applying the different TNM staging classifications in our large clinical practice. Some discrepancies will need welldesigned prospective studies for im4proving the actual classification.

HPV-negative Penile Intraepithelial Neoplasia (PeIN) With Basaloid Features

“…Clinical variables, including treatment and outcome, were collected from the medical records. The TNM staging was performed according to the eighth edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging manual 25. All samples and data were used in accordance with the ethical standards of 1964 Helsinki declaration and its later amendments or comparable ethical standards.…”

“…The TNM staging was performed according to the eighth edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging manual. 25 All samples and data were used in accordance with the ethical standards of 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Institutional Review Board of the Hospital Clínic of Barcelona (Protocol code HCB.2020.1207).…”

WHO 2022 classification of penile and scrotal cancers: updates and evolution

“…The value of HPV status as a prognosticator incorporated in the staging system remains to be seen in future studies. [40][41][42] Tumours of scrotum Scrotal tumours hold a unique histological perspective, owing to their description as the first occupational disease in "chimney sweepers". 13 The WHO 2022 emphasises that the scrotal precursor squamous lesions and invasive SCC, which are the commonest primary tumours, should be classified on similar lines as the penile classification.…”

Prognostic Significance of p16 and Its Relationship with Human Papillomavirus Status in Patients with Penile Squamous Cell Carcinoma: Results of 5 Years Follow-Up

“…Patients were considered to be pathologically node-negative if they were clinically node negative and remained relapse-free during follow-up. Histopathology results are reported according to the American joint Committee on Cancer (AJCC) 8th edition tumor, node, and metastases classification for PSCC [ 10 , 11 ].…”