Lymph Node Density Predicts Recurrence and Death After Inguinal Lymph Node Dissection for Penile Cancer

Overview

Journal Investig Clin Urol

Specialty Urology

Date 2017 Jan 19

PMID 28097264

Citations 7

Authors

Mark W Ball

Zeyad R Schwen

Joan S Ko

Alexa Meyer

George J Netto

Arthur L Burnett

Trinity J Bivalacqua

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine the impact of lymph node density (LND) on survival after inguinal lymph node dissection (ILND) for penile cancer.

Materials And Methods: Our institutional penile cancer database was queried for patients who underwent ILND. Clinicopathologic characteristics including LND and total number of positive lymph nodes (LNs) were analyzed to determine impact on recurrence-free survival (RFS) and overall survival (OS). LND, or the percent of positive LN out of total LN, was calculated as a categorical variable at varying thresholds.

Results: Twenty-eight patients with complete follow-up were identified. Indications for ILND were stage >T2 in 20 patients (71.4%), palpable adenopathy in 7 (25%), high grade T1 in 1 (3.6%). Median node yield was 17.5 (interquartile range, 12-22), and positive LNs were found in 14 patients (50%). RFS and OS were significantly lower for patients with >15% LN density (median RFS: 62 months vs. 6.3 months, p=0.0120; median OS: 73.6 months vs. 6.3 months, p<0.001). Controlling for age, medical comorbidities, number of positive LN, T stage, pelvic LN status and indication, LN density >15% was independently associated with worse RFS (hazard ratio [HR], 3.6; p=0.04) and OS (HR, 73.6; p=0.002). The c-index for LND was higher than total positive LNs for RFS (0.64 vs. 0.54) and OS (0.79 vs. 0.61).

Conclusions: In this small, retrospective penile cancer cohort, the presence of nodal involvement >15% was associated with decreased RFS and OS, and outperformed total number of positive LN as a prognostic indicator.

Citing Articles

Comparing T2-T3 staging of penile cancer according to the American Joint Committee on cancer 8 edition with two modified staging systems in predicting survival outcome: A single-center experience.

Kakoti S, Sureka S, Pathak A, Shah U, Mishra N, Puneeth Kumar K Indian J Urol. 2023; 39(1):53-57.

PMID: 36824107 PMC: 9942220. DOI: 10.4103/iju.iju_162_22.

"Light green up": Indocyanine Green Fluorescence Imaging-guided Robotic Bilateral Inguinal Lymphadenectomy by the Hypogastric Subcutaneous Approach for Penile Cancer.

Yuan P, Yao K, Zhou Z, Liu J, Li C, Hou W Eur Urol Open Sci. 2022; 45:1-7.

PMID: 36120419 PMC: 9478926. DOI: 10.1016/j.euros.2022.08.020.

The prognostic value of lymph node ratio in comparison to positive lymph node count in penile squamous cell carcinoma.

Yu J, Long Q, Zhang Z, Liao S, Zheng F Int Urol Nephrol. 2021; 53(12):2527-2540.

PMID: 34585313 PMC: 8599252. DOI: 10.1007/s11255-021-02996-3.

Impact of Examined Lymph Node Count and Lymph Node Density on Overall Survival of Penile Cancer.

Gao P, Zhu T, Gao J, Li H, Liu X, Zhang X Front Oncol. 2021; 11:706531.

PMID: 34307174 PMC: 8293298. DOI: 10.3389/fonc.2021.706531.

Nomogram prediction of overall survival based on log odds of positive lymph nodes for patients with penile squamous cell carcinoma.

Zheng W, Li K, Zhu W, Ding Y, Wu Q, Tang Q Cancer Med. 2020; 9(15):5425-5435.

PMID: 32519819 PMC: 7402844. DOI: 10.1002/cam4.3232.

References

Ornellas A, Kinchin E, Nobrega B, Wisnescky A, Koifman N, Quirino R . Surgical treatment of invasive squamous cell carcinoma of the penis: Brazilian National Cancer Institute long-term experience. J Surg Oncol. 2008; 97(6):487-95. DOI: 10.1002/jso.20980. View

Hakenberg O, Comperat E, Minhas S, Necchi A, Protzel C, Watkin N . EAU guidelines on penile cancer: 2014 update. Eur Urol. 2014; 67(1):142-150. DOI: 10.1016/j.eururo.2014.10.017. View

Stein J, Cai J, Groshen S, Skinner D . Risk factors for patients with pelvic lymph node metastases following radical cystectomy with en bloc pelvic lymphadenectomy: concept of lymph node density. J Urol. 2003; 170(1):35-41. DOI: 10.1097/01.ju.0000072422.69286.0e. View

Svatek R, Munsell M, Kincaid J, Hegarty P, Slaton J, Busby J . Association between lymph node density and disease specific survival in patients with penile cancer. J Urol. 2009; 182(6):2721-7. DOI: 10.1016/j.juro.2009.08.029. View

Zhu Y, Gu C, Ye D . Population-based assessment of the number of lymph nodes removed in the treatment of penile squamous cell carcinoma. Urol Int. 2013; 92(2):186-93. DOI: 10.1159/000354401. View

Kassouf W, Leibovici D, Munsell M, Dinney C, Grossman H, Kamat A . Evaluation of the relevance of lymph node density in a contemporary series of patients undergoing radical cystectomy. J Urol. 2006; 176(1):53-7. DOI: 10.1016/S0022-5347(06)00510-6. View

Ornellas A, Seixas A, DE MORAES J . Analyses of 200 lymphadenectomies in patients with penile carcinoma. J Urol. 1991; 146(2):330-2. DOI: 10.1016/s0022-5347(17)37784-4. View

Ku J, Kang M, Kim H, Jeong C, Kwak C, Kim H . Lymph node density as a prognostic variable in node-positive bladder cancer: a meta-analysis. BMC Cancer. 2015; 15:447. PMC: 4450458. DOI: 10.1186/s12885-015-1448-x. View

Lughezzani G, Catanzaro M, Torelli T, Piva L, Biasoni D, Stagni S . Relationship between lymph node ratio and cancer-specific survival in a contemporary series of patients with penile cancer and lymph node metastases. BJU Int. 2013; 116(5):727-33. DOI: 10.1111/bju.12510. View

10.

Daneshmand S, Quek M, Stein J, Lieskovsky G, Cai J, Pinski J . Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results. J Urol. 2004; 172(6 Pt 1):2252-5. DOI: 10.1097/01.ju.0000143448.04161.cc. View

11.

Ball M, Schwen Z, Ko J, Meyer A, Netto G, Burnett A . Lymph node density predicts recurrence and death after inguinal lymph node dissection for penile cancer. Investig Clin Urol. 2017; 58(1):20-26. PMC: 5240287. DOI: 10.4111/icu.2017.58.1.20. View

12.

Reddy J, Pettaway C, Levy L, Pagliaro L, Tamboli P, Rao P . Factors associated with regional recurrence after lymph node dissection for penile squamous cell carcinoma. BJU Int. 2016; 119(4):591-597. DOI: 10.1111/bju.13686. View

13.

Protzel C, Alcaraz A, Horenblas S, Pizzocaro G, Zlotta A, Hakenberg O . Lymphadenectomy in the surgical management of penile cancer. Eur Urol. 2009; 55(5):1075-88. DOI: 10.1016/j.eururo.2009.02.021. View

14.

Ravi R . Correlation between the extent of nodal involvement and survival following groin dissection for carcinoma of the penis. Br J Urol. 1993; 72(5 Pt 2):817-9. DOI: 10.1111/j.1464-410x.1993.tb16273.x. View

15.

Leijte J, Gallee M, Antonini N, Horenblas S . Evaluation of current TNM classification of penile carcinoma. J Urol. 2008; 180(3):933-8. DOI: 10.1016/j.juro.2008.05.011. View

16.

Zhu Y, Ye D, Yao X, Zhang S, Dai B, Zhang H . New N staging system of penile cancer provides a better reflection of prognosis. J Urol. 2011; 186(2):518-23. DOI: 10.1016/j.juro.2011.03.104. View

17.

Pandey D, Mahajan V, Kannan R . Prognostic factors in node-positive carcinoma of the penis. J Surg Oncol. 2006; 93(2):133-8. DOI: 10.1002/jso.20414. View

18.

Edge S, Compton C . The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010; 17(6):1471-4. DOI: 10.1245/s10434-010-0985-4. View

19.

Johnson T, Hsiao W, Delman K, Jani A, Brawley O, Master V . Extensive inguinal lymphadenectomy improves overall 5-year survival in penile cancer patients: results from the Surveillance, Epidemiology, and End Results program. Cancer. 2010; 116(12):2960-6. DOI: 10.1002/cncr.25091. View

20.

Li Z, Yao K, Chen P, Zou Z, Qin Z, Liu Z . Disease-specific survival after radical lymphadenectomy for penile cancer: prediction by lymph node count and density. Urol Oncol. 2014; 32(6):893-900. DOI: 10.1016/j.urolonc.2013.11.008. View