Risk Groups Systems for Penile Cancer Management: A Study of 203 Patients with Invasive Squamous Cell Carcinoma

OBJECTIVE: To evaluate the accuracy of previously published risk groups systems for predicting inguinal nodal metastases in patients with penile carcinoma.

METHODS: 203 cases of invasive penile squamous cell carcinomas were stratified using the following systems: Solsona et al (J Urol 2001;165:1509), Hungerhuber et al (Urology 2006;68:621), and the proposed by the European Association of Urology (Eur Urol 2004;46:1). Receiver-operator characteristic (ROC) analysis was carried out to compare accuracy in predicting final nodal status and cancer-related death.

RESULTS: Most of cases were pT2/pT3 high-grade tumors with a small percentage of low grade pT1 carcinomas. The metastatic rates for the Solsona et al, EUA, and Hungerhuber et al systems in the high risk category were 15/73 (21%), 16/103 (16%), and 10/35 (29%) in patients with clinically negative inguinal lymph nodes and 52/75 (69%), 55/93 (59%), and 34/47 (72%) in patients with palpable inguinal lymph nodes, respectively. Performance by ROC analysis showed a low accuracy for all stratification systems although the Solsona et al and the Hungerhuber et al systems performed better than the EAU system. Patients in intermediate risk categories and with clinically palpable inguinal lymph nodes were more likely to have nodal metastasis than patients with clinically negative lymph nodes in the same category.

CONCLUSIONS: These stratification systems may be useful for patients with low-grade superficial tumors and less accurate for evaluating patients with high-grade locally-advanced penile carcinomas. These data may be useful for therapeutic planning of patients with penile squamous cell carcinomas.

Urology. 2015 Jul 15. pii: S0090-4295(15)00406-9. doi: 10.1016/j.urology.2015.03.050. [Epub ahead of print]

Chaux A.

Department of Scientific Research, Norte University, Paraguay; Centro para el Desarrollo de la Investigación Científica (CEDIC), Paraguay.