How accurate are present risk group assignment tools in penile cancer?

Objectives  To evaluate the accuracy of the predictive models available to estimate the risk of lymph node metastases and cancer-specific survival in patients with squamous cell carcinoma of the penis. Methods  A nonsystematic review of the literature was performed searching MEDLINE in January 2008. Results  Most of the authors select patients for early inguinal lymphadenectomy according to the pathologic extension of the primary tumor and its histologic grade, as recommended by the EAU Guidelines and the Solsona risk groups. Although the Solsona risk groups performed slightly better, both risk groups had low predictive accuracy. A nomogram including eight clinical and pathologic variables (tumor thickness, microscopic growth pattern, Broder’s grade, presence of vascular or lymphatic embolization, infiltrations of the corpora cavernosa, corpus spongiosum or urethra, and the clinical stage of groin lymph nodes) was developed to estimate the risk of lymph node involvement at follow-up. Two nomograms are currently available able to estimate the 5-year cancer-specific survival probabilities of the patients. The first nomogram included the clinical lymph node stage and the same pathological variables of the primary tumor at penectomy, while the pathological stage of the lymph nodes replaced the clinical one in the second model. All the 3 nomograms had good prognostic accuracy. Conclusions  Both the Solsona and EAU risk group assessment had low prognostic accuracy, although the Solsona risk groups performed slightly better. The nomograms designed to predict the risk of lymph node metastases showed and cancer-specific survival had good prognostic accuracy but their external validation is still lacking.     

Prognostic factors in squamous cell carcinoma of the penis

Squamous cell carcinoma (SCC) of the penis is an uncommon disease in the US and Europe. Without treatment, patients with penile SCC usually die within 2 years after diagnosis of the primary lesion, because of uncontrollable locoregional disease or from distant metastases. The spread of the tumor to the locoregional lymph nodes (lymph-node positivity) is the most relevant prognostic factor. With the available treatments, 5-year cancer-specific survival probabilities are between 75% and 93% for those patients with clinically node-negative disease, and progressively lower for those with increasingly extensive node-positive disease. Similarly, patients with pathologically proven negative nodes have 5-year cancer-specific survival probabilities ranging from 85% to 100%. While patients with a single positive superficial lymph node on pathology have very good cancer-related outcomes, patients with multiple involved lymph nodes have significantly less favorable outcomes. This article focuses on the most important issues that surround the prognosis of squamous cell carcinoma of the penis, with special attention to the prognostic nomograms for penile cancer patients published in 2006.     

Nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis

PURPOSE: In penile cancer the therapeutic benefits of early inguinal lymphadenectomy must be counterbalanced by the high rates of morbidity, postoperative complications and mortality. A relevant aim is optimizing the selection of the patients who could really have the highest survival advantage from inguinal lymphadenectomy, limiting the cases in which this surgery might be considered over treatment with a risk of severe complications. We generated a nomogram estimating the risk of pathological inguinal lymph node involvement according to clinical lymph node stage and pathological findings of the primary tumor. MATERIALS AND METHODS: We retrospectively collected the clinical and pathological data of 175 patients who had undergone surgical therapy for squamous cell carcinoma of the penis from 1980 to 2002 at 11 urological centers in northeastern Italy. A logistic regression model was used to construct the nomogram. RESULTS: The presence of palpable groin lymph nodes and the histological findings of vascular and/or lymphatic embolization were important predictors of metastatic inguinal lymph node involvement. The nomogram predicting the risk of metastatic lymph node involvement showed a good concordance index (0.876) and good calibration. CONCLUSIONS: The clinical stage of groin lymph nodes and pathological findings of penectomy specimens allowed us to generate a nomogram to predict the probability of metastatic lymph node involvement in patients with squamous cell carcinoma of the penis. The statistical model showed an excellent ability to identify the patients with lymph node metastases and good calibration.     

Contemporary management of penile cancer including surgery and adjuvant radiotherapy: an experience in Taiwan

This retrospective study reports on the treatment outcomes of 45 men with penile cancer and seeks to address the issue concerning the treatment of inguinal lymph nodes (LN). Of these 45 patients, five had verrucous carcinoma and the other 40 had squamous cell carcinoma. Eighteen patients had inguinal lymph nodes (LNs) metastasis and received treatments of inguinal LNs involving bilateral inguinal LN dissection or unilateral inguinal LN dissection with or without postoperative radiotherapy. The median follow-up was 37 months. The ultimate local and regional controls for patients with verrucous carcinoma were 100 and 100%, respectively. Among the 40 patients with squamous cell carcinoma, the overall local control rate was 90%. The 5-year overall survival (OS) and disease-free survival (DFS) rates of patients without or with pathological inguinal LN metastasis were 70 vs. 22% (p=0.01), and 55 vs. 16% (p=0.004), respectively. The regional failure rates after inguinal LN dissection for pathological inguinal LN metastasis were 11% (1/9) and 60% (3/5) in patients with and without adjuvant radiotherapy. This study demonstrates that verrucous carcinoma shows excellent treatment outcomes following surgery alone. Squamous cell carcinoma of the penis is associated with a high incidence of inguinal lymph node metastasis. Elective groin dissection is indicated for all penile cancer patients except those with verrucous carcinoma and pT1 cancer with well-differentiated tumor. For patients with pathologically positive inguinal LN metastasis, adjuvant radiotherapy can increase inguinal control in this study. It warrants further prospective trial to prove the value of adjuvant radiotherapy in patients with pathological documented inguinal LN metastasis in penile cancer.     

Regional lymph node staging using lymphotropic nanoparticle enhanced magnetic resonance imaging with ferumoxtran-10 in patients with penile cancer

PURPOSE: We evaluated lymphotropic nanoparticle enhanced magnetic resonance imaging (LNMRI) with ferumoxtran-10 in determining the presence of regional lymph node metastases in patients with penile cancer. MATERIALS AND METHODS: Seven patients with squamous cell carcinoma of the penis underwent LNMRI. All patients subsequently underwent groin dissection and the nodal images were correlated with histology. RESULTS: We found that LNMRI had sensitivity, specificity, and positive and negative predictive values of 100%, 97%, 81.2% and 100%, respectively, in predicting the presence of regional lymph node metastases in patients with penile cancer. CONCLUSIONS: Lymph node scanning using LNMRI accurately predicts the pathological status of regional lymph nodes in patients with cancer of the penis. LNMRI may accurately triage patients for regional lymphadenectomy.     

What next? Managing lymph nodes in men with penile cancer

The management of patients with squamous cell carcinoma of the penis is often daunting given its rarity and subsequent lack of high-level evidence to support our decision-making. This culminates in the complex surgical issues involving the management of the regional lymph nodes, which is of critical importance to both quantity and quality of life for these patients. This review aims to highlight the decisive issues surrounding the management of the pelvic and inguinal lymph nodes in the setting of squamous cell carcinoma of the penis, and to spotlight recently published information that adds credence to accepted management strategies of both the clinically positive and negative groin after successful management of the primary lesion.Penile cancer remains an uncommon and potentially complex urological diagnosis in our practice in Canada. Although management of the primary lesion in itself is often problematic, any discussion or consideration of prognosis in patients with squamous cell carcinoma of the penis must also involve delineation of the presence and extent of metastatic disease to regional lymph nodes. Success in the management of penile cancer relies on the timely and appropriate management of the inguinal and pelvic lymph nodes.^1–3 This review aims to highlight the issues surrounding the management of the inguinal and pelvic lymph nodes in the setting of squamous cell carcinoma of the penis and to spotlight recently published information that adds credence to accepted management strategies or that approaches nodal disease in a novel or previously unexplored manner.In this review we will first focus on the management of the clinically positive groin, including lymph node dissection technique, as well as the management of pelvic lymph nodes and the role of chemotherapy in the neoadjuvant, adjuvant or palliative setting. Consideration will also be given to the management of the contralateral groin in unilaterally clinically positive disease. Many of the concepts presented are critical in describing and appreciating the often more complex clinical scenario of the patient with a clinically negative examination after successful management of the primary penile cancer. In highlighting the clinically negative groin, we discuss risk stratification based on the pathological characteristics of the primary lesion and the role of sentinel node biopsy and other methods of identifying occult metastasis.     

阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素分析

目的 探讨阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素,筛选淋巴结转移的高危患者.方法 回顾性分析81例阴茎鳞状细胞癌患者临床及病理资料.年龄27～81岁,中位年龄49岁.病程＜1年者46例(56.8%),≥1年者35例(43.2%).行单侧腹股沟淋巴结清扫6例,双侧腹股沟淋巴结清扫75例.按2002年TNM分期标准进行分期,并记录患者年龄、有无包皮过长/包茎史、肿瘤部位、大小、数目、形状、分级、腹股沟淋巴结体格检查情况和淋巴结大小等指标.结果 81例患者中经病理证实有区域淋巴结转移者pN+42例(51.9%),无淋巴结转移者pN0 39例(48.1%).G1、G2、G3患者区域淋巴结转移发生率分别为32.0%(16/50)、78.3%(18/23)和100.0%(8/8),各组间比较差异有统计学意义(P=0.015).根据腹股沟淋巴结体格检查结果,cN+和cN0患者区域淋巴结转移发生率分别为63.5%(40/63)和11.1%(2/18),2组差异有统计学意义(P=0.012).81例均获随访,随访时间2～127个月,中位时间40个月.腹股沟淋巴结转移阳性患者与阴性患者的5年无病生存率分别为71.4%与92.3%(P=0.005),5年总生存率分别为79.0%与91.4%(P=0.001),差异均有统计学意义.结论 腹股沟淋巴结体格检查结果和肿瘤分级是腹股沟区域淋巴结转移的独立危险因素.腹股沟淋巴结转移患者5年无病生存率和总生存率较低,对淋巴结转移高危患者,应采取积极治疗措施.     

阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素分析

目的 探讨阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素,筛选淋巴结转移的高危患者.方法 回顾性分析81例阴茎鳞状细胞癌患者临床及病理资料.年龄27～81岁,中位年龄49岁.病程＜1年者46例(56.8%),≥1年者35例(43.2%).行单侧腹股沟淋巴结清扫6例,双侧腹股沟淋巴结清扫75例.按2002年TNM分期标准进行分期,并记录患者年龄、有无包皮过长/包茎史、肿瘤部位、大小、数目、形状、分级、腹股沟淋巴结体格检查情况和淋巴结大小等指标.结果 81例患者中经病理证实有区域淋巴结转移者pN+42例(51.9%),无淋巴结转移者pN0 39例(48.1%).G1、G2、G3患者区域淋巴结转移发生率分别为32.0%(16/50)、78.3%(18/23)和100.0%(8/8),各组间比较差异有统计学意义(P=0.015).根据腹股沟淋巴结体格检查结果,cN+和cN0患者区域淋巴结转移发生率分别为63.5%(40/63)和11.1%(2/18),2组差异有统计学意义(P=0.012).81例均获随访,随访时间2～127个月,中位时间40个月.腹股沟淋巴结转移阳性患者与阴性患者的5年无病生存率分别为71.4%与92.3%(P=0.005),5年总生存率分别为79.0%与91.4%(P=0.001),差异均有统计学意义.结论 腹股沟淋巴结体格检查结果和肿瘤分级是腹股沟区域淋巴结转移的独立危险因素.腹股沟淋巴结转移患者5年无病生存率和总生存率较低,对淋巴结转移高危患者,应采取积极治疗措施.

Abstract：

Objective To explore the risk factors of inguinal metastasis in squamous cell carcinoma of the penis, screening lymph node metastasis high-risk patients. Methods The clinical and pathological data of 81 consecutive patients with squamous cell carcinoma of the penis were analyzed retrospectively. Age at presentation ranged from 27 to 81 years with a median of 49 years. Course of disease within one year of patients with 46 cases (56.8%), 1 year above 35 eases (43.2 %). Seventyfive patients underwent bilateral inguinal lymph node dissection, and 6 patients had unilateral inguinal lymph node dissection. Clinical stage of the primary tumor was assigned according to the 2002 TNM staging system. Variables included patients' age, redundant prepuce and/or phimosis, tumor site,size, number, macroscopic growth pattern, histological grade, inguinal physical examination and the size of inguinal lymph nodes. Results Of the 81 patients, 42 (51.9%) were staged as pN+ and 39 (48. 1%) as pN0. Metastases occurred in 32.0% (16/50) of G1, 78.3% (18/23) of G2 and 100. 0%(8/8) of G3 cases, with significant differences among them (P= 0. 015). According to the inguinal lymph node physical examination results, 63 were staged as clinically node-positive (cN+) and 18 as clinically node-negative (cN0). Metastases occurred in 63. 5% (40/63) of cases of cN+, as compared with 11.1% (2/18) of cases of cN0(P=0. 012). At a median follow up of 40 months (ranged 2-127 months), the 5-year disease free survival rates for positive and negative inguinal lymph nodes metastasis were 71.4% and 92.3%, respectively (P=0. 005) , and the 5-year cancer specific survival rates were 79.0% and 91.4%, respectively (P=0.001). Conclusions Inguinal physical examination and histological grade were the strongest predictors of inguinal metastasis. The patients with inguinal lymph nodes metastasis have lower 5-year disease free survival rates and cancer specific survival rates,and should receive positive treatment measures.     

阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素分析

目的 探讨阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素,筛选淋巴结转移的高危患者.方法 回顾性分析81例阴茎鳞状细胞癌患者临床及病理资料.年龄27～81岁,中位年龄49岁.病程＜1年者46例(56.8%),≥1年者35例(43.2%).行单侧腹股沟淋巴结清扫6例,双侧腹股沟淋巴结清扫75例.按2002年TNM分期标准进行分期,并记录患者年龄、有无包皮过长/包茎史、肿瘤部位、大小、数目、形状、分级、腹股沟淋巴结体格检查情况和淋巴结大小等指标.结果 81例患者中经病理证实有区域淋巴结转移者pN+42例(51.9%),无淋巴结转移者pN0 39例(48.1%).G1、G2、G3患者区域淋巴结转移发生率分别为32.0%(16/50)、78.3%(18/23)和100.0%(8/8),各组间比较差异有统计学意义(P=0.015).根据腹股沟淋巴结体格检查结果,cN+和cN0患者区域淋巴结转移发生率分别为63.5%(40/63)和11.1%(2/18),2组差异有统计学意义(P=0.012).81例均获随访,随访时间2～127个月,中位时间40个月.腹股沟淋巴结转移阳性患者与阴性患者的5年无病生存率分别为71.4%与92.3%(P=0.005),5年总生存率分别为79.0%与91.4%(P=0.001),差异均有统计学意义.结论 腹股沟淋巴结体格检查结果和肿瘤分级是腹股沟区域淋巴结转移的独立危险因素.腹股沟淋巴结转移患者5年无病生存率和总生存率较低,对淋巴结转移高危患者,应采取积极治疗措施.     

Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases

PURPOSE: In this retrospective study we compared the clinical outcome of early vs delayed excision of lymph node metastases in patients with penile squamous cell carcinoma. MATERIALS AND METHODS: A total of 40 patients with a T2-3 penile carcinoma with lymph node metastases were included in this study. All patients initially presented with bilateral impalpable lymph nodes. In 20 patients (50%) metastases were removed when they became clinically apparent during meticulous followup (median interval 6 months, range 1 to 24). There were 20 patients (50%) who underwent resection of inguinal metastases detected on dynamic sentinel node biopsy before they became palpable. The histopathological characteristics of the tumors and lymph nodes were reevaluated. RESULTS: The 2 populations were similar in terms of patient age, T-stage, pathological tumor grade, vascular invasion and infiltration depth. Disease specific 3-year survival of patients with positive lymph nodes detected during surveillance was 35% and in those who underwent early resection, 84% (log rank p = 0.0017). In multivariate analysis early resection of occult inguinal metastases detected on dynamic sentinel node biopsy was an independent prognostic factor for disease specific survival (p = 0.006). CONCLUSIONS: Early resection of lymph node metastases in patients with penile carcinoma improves survival.     

阴茎癌51例诊治体会

目的探讨阴茎癌有效合理的诊断及治疗方法。方法回顾性分析51例阴茎癌患者的临床资料，其中鳞状细胞癌44例，鳞状上皮乳头状瘤恶变7例。均行手术治疗，其中行单纯肿瘤切除＋包皮环切术2例，阴茎部分切除术36例，阴茎全切＋尿道会阴部造口术13例，行双侧腹股沟淋巴结清扫术11例。结果41例获得随访，行阴茎部分切除术者2年和5年生存率分别为83．3％和76．7％，行阴茎全切除术者2年和5年生存率分别为72．7％和63．6％。结论阴茎癌早期诊断并予以手术为主的治疗对于改善患者预后十分重要，证实有淋巴结转移者应积极行髂腹股沟淋巴结清扫术。     

Carcinoma of penis: report of 59 cases and review of literature

PURPOSE: To analyze the characteristics and prognostic factor of penile cancer, we retrospectively reviewed the clinicopathological data of patients with a diagnosis of penile cancer treated. PATIENTS AND METHODS: The records of 59 patients (median age 66, ranged from 47 to 91) with squamous cell carcinoma of the penis reffered between April 1988 and January 2006 were reviewed. The importance of tumor size and stage, differentiation, type of infiltration, vascular invasion, patient age, lymph node metastasis, distant metastasis and type of therapy were assessed using univariate and multivariate analyses. RESULTS: After a mean follow up of 37.7 months, 13 cases (22.0%) died of cancer and 5-year survival was 67.4%. Multivariate analysis demonstrated that, type of operation (p = 0.0471, Hazard ratio 3.364), vascular invasion (p = 0.0014, Hazard ratio 5.921) were associated with survival. CONCLUSION: Vascular invasion and type of operation were related to survival. Our findings indicate that correct pathological diagnosis and appropriate treatment may lead to prolonged survival.     

Lymph node micrometastasis and prognosis in patients with oesophageal squamous cell carcinoma

BACKGROUND: The purpose of this study was to investigate whether the presence of lymph node micrometastasis in pathological lymph node-negative (pN0) oesophageal squamous cell carcinoma had prognostic value. METHODS: Some 1840 lymph nodes were obtained from 50 patients with pN0 oesophageal squamous cell carcinoma who underwent curative resection of the primary tumour with systematic lymphadenectomy. These lymph nodes were examined immunohistochemically with anticytokeratin antibody (AE1/AE3). Lymph node micrometastases newly detected by immunohistochemistry were classified as micrometastasis. Additionally, lymph node micrometastases were classified into three stages: stage 1, one individual AE1/AE3-positive cell; stage 2, multiple individual positive cells; stage 3, one or multiple positive clusters. RESULTS: Micrometastases were detected in 20 patients (40 per cent). A higher stage of micrometastasis was associated with greater pathological tumour (pT) size (P = 0.023). Recurrent tumours developed in nine patients. However, the frequency of recurrence was similar in patients with, or without, micrometastasis (five of 20 and four of 30 patients respectively; P = 0.25). Twenty-three of 30 patients without micrometastasis survived, whereas 15 of 20 patients with micrometastasis were still alive (5-year overall survival 75 and 78 percent respectively, P = 0.91). Twenty-six of 30 patients without micrometastasis had no recurrence, whereas 15 of 20 patients with micrometastasis had no recurrence (5-year relapse-free survival 86 and 73 per cent respectively, P = 0.37). There was no significant difference in prognosis with respect to the stages of micrometastasis. Multivariate analysis also showed that micrometastasis was not an independent prognostic factor (P = 0.73). CONCLUSION: Immunohistochemical detection of lymph node micrometastasis may be an indicator of lymphatic dissemination of tumour cells. However, the presence of micrometastasis had no impact on the prognosis of node-negative patients with oesophageal squamous cell carcinoma.     

Iliac nodal metastases from carcinoma of the penis treated surgically

OBJECTIVE: To evaluate survival in patients with metastatic iliac nodal involvement from carcinoma of the penis. PATIENTS AND METHODS: Thirteen patients with metastases to the iliac nodes were selected from 68 with squamous cell carcinoma of the penis who had undergone amputation and bilateral ilio-inguinal lymphadenectomy. The 1978 Tumour-Nodes-Metastasis system was used for staging. Deep and superficial lymph nodes were removed during the inguinal procedure. Lymph nodes below the common iliac artery (external and obturator) were removed and histologically evaluated for the presence of metastases. RESULTS: The mean (median, range) follow-up was 55.5 (8. 8, 0.3-235) months, at the end of which five patients were free of cancer, seven had died from cancer or treatment-related complications and one was lost to follow-up. Four of the five survivors had metastases to only one iliac lymph node. CONCLUSION: Ilio-inguinal lymphadenectomy may have a significant role in increasing the survival of patients with metastases to only one iliac lymph node.     

Modified radical inguinal lymphadenectomy for carcinoma of the penis: technique and results

PURPOSE: Modified radical inguinal lymphadenectomy for carcinoma of the penis is presented that satisfies the requirement for complete groin dissection, while significantly decreasing postoperative complications. MATERIALS AND METHODS: Eight patients with squamous cell carcinoma and 2 with leiomyosarcoma of the penis underwent bilateral modified inguinal lymphadenectomy, including removal of the superficial and deep inguinal lymph nodes. To avoid damage to the vessels of the groin region that run parallel to the inguinal ligament and lie in the fat of the superficial layer of the superficial fascia dissection is done beneath this layer. The proper cleavage plane is just above the membranous layer of the superficial fascia, beneath which the superficial inguinal lymph nodes are located. The saphenous vein is preserved and the sartorius muscle is left in situ, so as not to disturb collateral lymphatic drainage. RESULTS: At a followup of 6 to 104 months no skin necrosis, infection or deep venous thrombosis occurred. In 2 patients early moderate lymphedema of the lower extremities resolved with time, 2 had scrotal edema and 3 had a transient lymphocele. CONCLUSIONS: As described, modified radical inguinal lymphadenectomy decreases the morbidity associated with groin dissection, while removing superficial and deep inguinal lymph nodes.     

建立预测阴茎鳞状细胞癌区域淋巴结转移风险的列线图

目的 根据阴茎癌原发灶的病理指标,建立预测阴茎鳞状细胞癌区域淋巴结转移风险的列线图. 方法 收集1990-2005年73例阴茎鳞状细胞癌患者资料,患者均接受阴茎肿瘤切除和区域淋巴结清扫术.免疫组化法检测分子指标(p53、Ki-67、E-cadherin和MMP-9)的表达水平.采用Logistic回归模型建立列线图.预测淋巴结转移的变量包括年龄、分期、分级、蛋白表达水平(p53、Ki-67、E-cadherin和MMP-9)和脉管侵犯.其中年龄为连续变量,分期、分级、蛋白表达水平和脉管侵犯为分类变量. 结果 肿瘤分级、p53表达水平和脉管侵犯是预测区域淋巴结转移的独立预后因素(P<0.05),回归系数分别为3.97、2.12和2.37,OR值分别为52.99、8.33和10.70.用于预测淋巴结转移风险的列线图显示出良好的一致系数(0.92)和良好的校准. 结论 基于阴茎鳞状细胞癌原发灶的病理特征,构建预测区域淋巴结转移风险的列线图,不仅有助于个体化的判断肿瘤转移的风险,并且有助于与患者的交流和治疗选择.     

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

Objective

To evaluate factors in penile squamous cell carcinoma predictive of pelvic lymph node metastasis and survival.

Materials and methods

Data were collected and analyzed retrospectively in 146 patients with squamous cell carcinoma of penis who underwent bilateral inguinal lymph node dissection in our center between January 1998 and April 2011. Variables recorded included serum squamous cell carcinoma antigen, primary tumor p53 immunoreactivity, histological grade, pathological tumor stage, lymphatic or vascular invasion, absent/unilateral or bilateral inguinal lymph node involvement, number of metastatic inguinal lymph nodes, presence of extracapsular growth and lymph node density.

Results

Seventy patients had inguinal lymph node metastasis (LNM). Of these, 33 (47.1 %) had pelvic LNM. Primary tumor strong p53 expression, lymphatic or vascular invasion, involvement of more than two inguinal lymph nodes and 30 % or greater lymph node density were significant predictors of pelvic LNM. Primary tumor strong p53 expression (odds ratio [OR] 5.997, 95 % confidence intervals [CI] 1.615–22.275), presence of extracapsular growth (OR 2.209, 95 % CI 1.166–4.184), involvement of more than two inguinal lymph nodes (OR 2.494, 95 % CI 1.086–5.728) and pelvic lymph node involvement (OR 18.206, 95 % CI 6.807–48.696) were independent prognostic factors for overall survival.

Conclusions

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.     

The Treatment of Penile Carcinoma: Experience in 64 Cases

Introduction: Carcinoma of the penis is an uncommon entity in Poland (160 new cases per year). Purpose: To review our results in treatment of penile cancer in 64 patients. Material and methods: From 1989 to 1998, 64 patients were treated for carcinoma of the penis. The age of the patients varied from 21 to 86. Clinical and pathological categories were assessed according to TNM classification. Inguinal lymphadenectomy was performed in 35 patients. Following surgery 12 patients underwent radiotherapy, 3 chemotherapy, 3 radiotherapy and chemotherapy. Results: Twenty-two percent of patients died of cancer with median survival of 49 weeks. Bilateral inguinal involvement after node dissection was found in 17 patients. Unilateral inguinal involvement was found in 7 patients. Six patients had positive pelvic nodes. Of patients with initially non metastatic disease (N0) 8.3% showed progression to death, of patients with initially lymph node metastases (N+) 46% showed progression to death. The 5-year disease-free survival rates of patients with N+ and N0 were 40% and 82%, respectively. Of the patients 11% had local recurrence. Postoperative complications developed in 30 cases. Conclusions: The likelihood of lymph node invasion at presentation was related to T category and grade of primary tumour. The most important prognostic factor for patients with carcinoma of the penis was lymph node involvement.     

Extranodal extension in regional lymph nodes is associated with outcome in patients with renal cell carcinoma

PURPOSE: The 2002 American Joint Committee on Cancer pN classification for renal cell carcinoma is based on the number of positive regional lymph nodes. We examined the associations of pathological features of lymph node metastases with patient outcome to improve the prognostic accuracy of the current classification. MATERIALS AND METHODS: We studied the records of 2,076 patients treated with radical nephrectomy for unilateral, sporadic pM0 renal cell carcinoma between 1970 and 2000. There were 34 patients with metastasis in a single regional lymph node (pN1) and 35 with metastases in more than 1 lymph node (pN2). Pathological features of lymph node metastases, including the number and percent of positive lymph nodes, total number of lymph nodes removed, grade, necrosis, extranodal extension, and largest dimension and surface area of metastases were determined by 2 urological pathologists (HHD and JCC). RESULTS: There was no statistically significant association between the pN classification and death from renal cell carcinoma (pN2 vs pN1 RR 1.05, 95% CI 0.62 to 1.79, p = 0.846). However, patients with extranodal extension were twice as likely to die of renal cell carcinoma than patients in whom metastases did not extend outside of the lymph node capsule (RR 2.02, 95% CI 1.18 to 3.45, p = 0.010). The 5-year cancer specific survival rate was 18% and 35% in patients with and without extranodal extension, respectively. CONCLUSIONS: We believe that a pN classification based on the presence or absence of lymph node metastases with a notation regarding the presence or absence of extranodal extension represents a significant improvement in the prognostic accuracy of the current pN classification.     

阴茎鳞状细胞癌淋巴结清扫术后复发类型及预后因素分析

目的 评估阴茎癌原发灶切除术及标准淋巴结清扫术后复发类型和影响预后的可能因素. 方法 回顾性分析1990 -2005年73例阴茎鳞状细胞癌患者资料.阴茎部分切除62例,阴茎全切11例.73例均接受区域淋巴结清扫.随访时间16 ～183个月,平均32个月.免疫组化法检测肿瘤细胞p53和Ki-67的表达水平.统计学分析患者复发类型、病理特征及预后. 结果 患者术后肿瘤复发20例(27.4％),复发时间为术后6 ～ 17个月,平均11个月,其中3例在末次随访时仍存活.复发患者的肿瘤特异性生存时间为16 ～83个月,平均26个月.远处及多处复发为高级别肿瘤的常见复发类型(P =0.017).单因素分析显示肿瘤分期、病理分级、淋巴结转移、淋巴结外累及和p53蛋白表达水平与3年无病生存率降低密切相关.多因素分析显示只有病理分级(P =0.025)和淋巴结状态(P =0.024)是无病生存率的独立预后因素. 结论 病理分级和淋巴结状态是阴茎癌无病生存率的独立预后因素,高级别肿瘤易发生远处及多处复发.