Prognostic Factors In Invasive Squamous Cell Carcinoma Of The Penis: Analysis Of 196 Patients Treated At The Brazilian National Cancer Institute

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 15 Sep 2008 - 1:00 PDT

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UroToday.com - Cancers of the penis are uncommon tumors in the Brazilian male population, but they are a significant health problem in some regions of the country. The superficial location of these tumors provides the opportunity for early detection and conservative treatment. Unfortunately, delay on the part of the physician in initiating diagnosis may be considerable and many patients are referred to treatment after developing advanced disease. The tumor usually spreads through penile lymphatic vessels progressing with inguinal and regional lymph node metastases. Many patients with clinically non-suspicious nodes and a significant number with enlarged nodes do not have metastatic spread. Physical examination is not a reliable predictor of lymph node status and the only reliable staging information may be acquired through a surgical procedure with subsequent histological examination of the inguinal lymph nodes. Inguinal lymphadenectomy can be curative for early metastatic disease, but it has significant morbidity and ideally would be performed only for patients at risk for metastatic disease

The aim of our study was to find a clinicopathological indicator of inguinal lymph node involvement. We evaluated the clinical and pathological parameters with prognostic value, regarding the incidence of metastasis and overall survival rates in 196 patients treated at our institution.

The presence and the extent of metastasis to the inguinal region are the most powerful prognostic factors for survival in patients with squamous cell carcinoma of penis (SCCP). Pathological factors with prognostic value, other than lymph node metastasis, were stage, grade, tumor invasion depth, corpora cavernosa infiltration, perineural infiltration, lymphovascular embolization and absent koilocytosis. However, only lymphovascular embolization and absent koilocytosis were independent prognostic factors for the risk of lymphatic metastasis. Patients without lymphovascular embolization and with koilocytosis also had better 5-year survival.

Accurate diagnosis and staging are essential to proper treatment planning. To date, however, a uniform assessment of guidelines for the treatment of penile carcinoma is still lacking, especially regarding the indications of lymphadenectoy in SCCP. Surgical ablation deserves the outmost consideration in the management of penile carcinoma, as it allows extensive histological sampling and therefore a more accurate staging and grading of the primary lesion - providing at the time a cure as well as information about adequate clearing of tumoral tissue after treatment. The presence of lymphatic or venous tumor emboli and the absence of koilocytosis were, in our study, the most important factors in predicting lymph node metastases.

Although the criteria for selection of patients for lymphadenectomy remain controversial and the role and timing of lymphadenectomy in patients with clinically negative nodes are still matters of debate, in our opinion all patients with these predictive factors must be submitted to lymph nodal dissection.

Written by Antonio Augusto Ornellas MD, PhD, as part of Beyond the Abstract on UroToday.com

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