To identify factors associated with regional recurrence (RR) following lymphadenectomy for penile cancer in order to determine which patients might benefit from adjuvant therapy.
Men who underwent lymphadenectomy for penile squamous cell carcinoma from 1977-2014 were identified from an institutional database. Kaplan-Meier curves estimated recurrence-free survival (RFS) calculated from the date of lymphadenectomy. Cox regression models evaluated the association between RFS and patient and tumor characteristics.
182 men who underwent lymphadenectomy for penile cancer were identified. Median patient age was 62 years and median follow-up was 4.2 years. 34 men experienced RR following lymphadenectomy, of which 24 developed isolated RR without distant metastasis. Median RFS was 5.7 months, and the 3-year RFS rate was 70%. On univariate analysis, lymphovascular invasion, clinical and pathologic nodal stage, pathologic inguinal laterality, pelvic nodal involvement, lymph node density >5.2%, >3 pathologically-involved lymph nodes, and extranodal extension (ENE) were associated with worse RFS (p<0.05 for all). On multivariate analysis, clinical N3 disease (AHR 3.53, 95% CI: 1.68-7.45, p=0.001), >3 pathologically involved lymph nodes (AHR 3.78, 95% CI: 2.12-6.65; p<0.0001), and ENE (AHR 3.32, 95% CI: 1.93-5.76; p<0.0001) were associated with worse RFS. The 3-year RFS for patients with cN0, cN1, cN2, and cN3 disease was 91.7%, 64.5%, 54.7%, and 38.3% respectively. For men with >3 involved nodes, 3-year RFS was 17% vs 82.4% in men with <3 involved nodes. 3-year RFS was 29.7% in men with ENE and 85.7% in men without ENE.
The presence of clinical N3 disease, >3 pathologically involved lymph nodes, and ENE were associated with worse RFS. Since RR portends a dismal prognosis with few salvage options, adjuvant therapies should be developed for men with the aforementioned adverse factors. This article is protected by copyright. All rights reserved.
BJU international. 2016 Oct 18 [Epub ahead of print]
Jay P Reddy, Curtis A Pettaway, Lawrence B Levy, Lance C Pagliaro, Pheroze Tamboli, Priya Rao, Isuru Jayaratna, Karen E Hoffman
Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., Departments of Urology The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Medical Oncology, Mayo Clinic, Rochester, MN., Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX., Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. .