Delay to Inguinal Lymph Node Dissection Greater than 3 Months Predicts Poorer Recurrence-Free Survival for Patients with Penile Cancer

Penile cancer is a rare disease which requires a thorough initial clinical assessment of the inguinal lymph nodes as an essential component for prognostic survival factor for patients. Current data suggests that early or immediate inguinal lymph node dissection (ILND) increases survival outcome for patients, though that is not clearly certain. Early ILND is defined as procedure performed within 6 weeks of primary treatment. To confirm whether early ILND is beneficial for patients, the goal of this study was to analyze predictors of regional recurrence as well as disease-specific survival based on time of ILND.

This was a retrospective study that reviewed 84 consecutive patients’ medical records who presented with clinically nonmetastatic squamous cell carcinoma of the penis. Collected variables include age, race, ethnicity, clinical and pathological tumor (pT) and node (pN) staging, tumor grade and the presence of lymphovascular invasion, perineural invasion or extranodal extension. Recurrence-free and disease-specific survival was estimated using the Kaplan-Meier method, while optimal time to ILND was assessed by ROC curves and used for dichotomization.

Of the 84 patients, 47 and 37 patients presented with cNO and cN+ disease, retrospectively. Median patient age was 64.5 years and median follow-up was 20.8 months. Results showed that early dissection in 51 men showed 5-year recurrence-free survival of 77% vs 37.8% in 33 who underwent delayed dissection. Positive node disease and early inguinal lymph node dissection were predictors of regional recurrence. Five-year disease-specific survival was 64.1% and 39.5% in the early and late dissection groups, respectively.

In conclusion, a short-term follow-up period of 3 months was the most optimal window to perform ILND. This study may help delineate patterns of referral and timing or surgical intervention. Future prospective trials or studies will be needed to further clarify the role of surgery in the multidisciplinary management of the nodes in patients with penile cancer. Some limitations that the authors noted were the retrospective design of the study and small sample size.

Written by: Zhamshid Okhunov, MD, University of California Irvine

References
1. Peters CA, Skoog SJ, Arant BS Jr et al: Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol 2010; 184: 1134

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