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

It is unknown if concomitant inguinal lymph node dissection (ILND) at time of penectomy improves outcomes for penile cancer patients. We analyzed predictors for regional recurrence as well as recurrence free (RFS) and disease specific (DSS) survival based on time of ILND, and determine an optimal time for performance of ILND.

We reviewed 84 consecutive patients with available nodal pathology. Both RFS and DSS were estimated using the Kaplan-Meier method. Optimal time to ILND was assessed by receiver operating characteristic curves and used for dichotomization. Cox proportional hazard risk (HR) was used to identify predictors for regional recurrence after ILND.

In total, 47 (56%) and 37 (44%) patients presented with cN0 and CN+ disease, respectively, over a median follow-up of 21 months. Cut-point value of 3 months for performance of ILND was used to dichotomize cohort as early versus delayed. Early Dissections(n=51) demonstrated a 5-yr RFS of 77 vs. 37.8% for those who received delayed dissections (n=33). Positive node disease (HR=23.2, 2.98-181.2) and early ILND(HR=0.48, 0.21-0.98) were predictors of regional recurrence. Five-year DSS was 64.1 and 39.5% for the early vs. late dissection groups, respectively.

Three months appears as an optimal window for performing ILND. While prospective trials will define the role of upfront groin dissection, our results may help delineate patterns of referral and timing of ILND for penile cancer patients.

The Journal of urology. 2017 Jun 23 [Epub ahead of print]

Juan Chipollini, Doninic H Tang, Scott M Gilbert, Michael A Poch, Julio M Pow-Sang, Wade J Sexton, Philippe E Spiess

Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL. Electronic address: ., Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.