INGUINAL LYMPH NODES CHARACTERISTICS PREDICT PELVIC LYMPH NODES INVOLVEMENT IN PENILE CANCER: A SINGLE-INSTITUTIONAL EXPERIENCE

Mario Catanzaro1, Giovanni Lughezzani2, Andrea Guttilla3, Tullio Torelli1, Silvia Stagni1, Davide Biasoni1, Nicola Nicolai1, Luigi Piva1, Andrea Necchi1, Patrizia Giannatempo1, Daniele Raggi1, Roberto Salvioni1
  • 1 Fondazione IRCSS Istituto Nazionale dei Tumori, Unità di Urologia (Milano)
  • 2 Università Vita-Salute San Raffaele, Unità di Urologia (Milano)
  • 3 Clinica Urologica Università di Padova, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche (Padova)

Objective

Concomitant pelvic lymphadenectomy (pLND) in patients with penile cancer (PC) with inguinal lymph nodes metastases (iLNM) is debate. We aimed at determining predictors of pLNM in a population with iLNM.

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Methods and results

A total of 261 N+ groins were retrieved from our database. A concomitant pLND was performed in case of clinically evident N+. In case of low-volume inguinal disease, the decision to perform a deferred pLND was detemined based on pathological inguinal nodes characteristics. Logistic regression models (LRMs) were fitted to test the predictors of pLNM. The Mazumdar-Glassman method was used to determine the most significant cut-off values for each predictor.
pLNM were observed in 48 (18.3%) cases. The mean of positive inguinal and pelvic lymph nodes was 1.9 (range:1-8) and 1.2 (range: 0-12), respectively. Mean iLNM volume was 3.3 cm (range: 1-10 cm). At univariable LRMs, both the number of iLNM (OR: 1.51: 95% CI: 1.20-1.90; p<0.001) and the volume of iLNM (OR: 1.02: 95% CI: 1.01-1.04; p=0.027) emerged as significant predictors of pLNM. The two variables were independent predictors of pLNM in multivariable LRMs (p=0.022 and 0.029, respectively). The most signifcant cut-off values were respectively 3 for the number of iLNM and 4 cm for the volume of iLNM. Patients with ≥3 iLNM had a 2.82-fold higher risk of harbouring pLNM relative to patients with ≤2 iLNM (95% CI: 1.45-5.49; p=0.002). Similarly, patients with a iLNM ≥4 cm had a 2.37-fold higher risk of harbouring pLNM relative to individuals with LNM≤4 cm (95% CI: 1.12-5.05; p=0.025). In the current series, no significant relationship was observed between the presence of extranodal extension of the disease and pLNM (p=0.174).

Discussion

pLND should be carefully evaluated in patients with PC and iLNM. The number and volume of inguinal LNM should be taken into account when determining the need for a concomitant pLND.

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