Lymph Node Metastasis in Intermediate-Risk Penile Squamous Cell Cancer: A Two-Centre Experience

Lymph Node Metastasis in Intermediate-Risk Penile Squamous Cell Cancer: A Two-Centre Experience

Abstract Background The risk of lymph node (LN) metastasis in G2T1 penile cancer has been previously reported as 0–50% and is classified as “intermediate” in the European Association of Urology (EAU) guidelines. The management of impalpable regional nodes in this cohort of patients remains contentio...

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Published in:European urology Vol. 57; no. 4; pp. 688 - 692
Main Authors: Hughes, Ben E, Leijte, Joost A.P, Kroon, Bin K, Shabbir, Majid A, Swallow, Tom W, Heenan, Sue D, Corbishley, Cathy M, van Boven, Hester H, Perry, Matthew J.A, Watkin, Nick A, Horenblas, Simon
Format: Journal Article
Language:English
Published: Kidlington Elsevier 01-04-2010
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Carcinoma, Squamous Cell - mortality
Carcinoma, Squamous Cell - secondary
Carcinoma, Squamous Cell - surgery
Databases as Topic
Disease-Free Survival
Hematologic and hematopoietic diseases
Humans
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
London
Lymph Node Excision - adverse effects
Lymphatic Metastasis
Male
Medical sciences
Middle Aged
Neoplasm Staging
Nephrology. Urinary tract diseases
Netherlands
Palpation
Penile Neoplasms - mortality
Penile Neoplasms - pathology
Penile Neoplasms - surgery
Risk Assessment
Risk Factors
Sentinel Lymph Node Biopsy
Time Factors
Treatment Outcome
Urology
Watchful Waiting
London
Netherlands
Lymph node metastasis
Penile cancer
G2T1
Squamous cell carcinoma
Nephrology
Malignant lymphadenopathy
Malignant hemopathy
Malignant tumor
Urology
Penile diseases
Risk factor
Penis cancer
Male genital diseases
Cancer
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Summary:Abstract Background The risk of lymph node (LN) metastasis in G2T1 penile cancer has been previously reported as 0–50% and is classified as “intermediate” in the European Association of Urology (EAU) guidelines. The management of impalpable regional nodes in this cohort of patients remains contentious and varies among treatment centres depending on tumour factors and local resources. Objectives To establish the risk of LN metastasis in G2T1 disease. Design, settings, and participants We interrogated the databases of two referral centres for penile cancer. Measurements Out of 902 patients, 117 (13%) patients were identified with G2T1 cancers. Those with palpable inguinal nodes (cN1) underwent early inguinal LN dissection (iLND). Those with clinically node negative (cN0) inguinal basins were either observed or surgically staged with iLND or by dynamic sentinel LN biopsy (DSLNB). Median follow-up was 44 mo, with minimum follow-up of 6 mo. Results and limitations Fifteen of 117 (13%) patients with G2T1 cancer had LN metastasis at initial staging or during follow-up. Six of 12 (50%) cN1 patients had histologically proven LN metastasis on iLND. One hundred five patients were cN0 at presentation. Ten cN0 patients had prophylactic iLND, none of which yielded LN metastasis; 5 of 64 (8%) cN0 patients who had DSLNB had tumour-positive LNs, and 4 of 31 (13%) cN0 patients who were observed developed LN metastasis during follow-up. In cN0 patients, the risk of LN metastasis at initial staging or during surveillance was 9%. Conclusions We consider that in cN0 patients with G2T1 penile cancer, the risk of developing metastases during surveillance warrants surgical and potentially curative staging. However, the morbidity of prophylactic bilateral iLND is too great to justify a detection rate of 9%. Less morbid alternatives such as DSLNB are advisable in G2T1 disease.
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ISSN:0302-2838
1873-7560
DOI:10.1016/j.eururo.2009.07.004