Objective
To examine the risk factors associated with upstaging at inguinal lymph node dissection
(ILND) in men with penile cancer and clinically negative lymph nodes (cN0) using a
large US cancer database.
Methods
The National Cancer Data Base was queried from 1998 to 2012 to identify men with penile
cancer who underwent ILND and had complete clinical or pathologic node status available.
Lymphovascular invasion (LVI) was available after 2010. Multivariate logistic regression
evaluated factors (cT stage, grade, LVI) associated with pathologic nodal upstaging
in those with cN0 disease. Correlations between clinical and pathologic node status
were also calculated with weighted kappa statistics.
Results
Complete clinical and pathologic LN status was available for 875 patients. Of these,
461 (53%) were cN0. Upstaging occurred in 111 (24%). When stratified by low, intermediate,
and high-risk groups, the proportion with pathologically positive LNs was 16%, 20%,
and 27%, respectively (P = .12). On multivariate analysis, limited to men with LVI data available (N = 206),
LVI (odds ratio 3.10, 95% confidence interval 1.39-6.92), but not increasing stage (univariate only) or grade (univariate only), was
significantly associated with upstaging at ILND.
Conclusion
In this analysis, of 461 patients with node-negative penile cancer undergoing ILND,
upstaging was observed in 24%. LVI was the strongest independent predictor of occult
lymph node disease. These findings corroborate the presence of LVI as the significant
risk factor for occult micrometastases and suggest a possible improvement in existing
risk stratification groupings, with the presence of LVI, regardless of stage or grade,
to be considered high-risk disease.
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Article info
Publication history
Published online: July 19, 2016
Accepted:
June 21,
2016
Received:
March 26,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Corrigendum to “Predictors of Nodal Upstaging in Clinical Node Negative Patients With Penile Carcinoma: A National Cancer Database Analysis”[Urology 96 (2016) 29-34]UrologyVol. 108
- Re: Winters et al.: Predictors of Nodal Upstaging in Clinical Node Negative Patients With Penile Carcinoma: A National Cancer Database Analysis (Urology 2017;96:29-34)UrologyVol. 100
- PreviewWe read with great interest the recently published article by Winters and colleagues examining risk factors associated with upstaging at inguinal lymph node dissection (ILND) in men with penile cancer and clinically negative lymph nodes (cN0) identified from the National Cancer Database.1 From this cohort of 875 patients, the authors found that 24% of patients with cN0 disease were upstaged at ILND and determined that lymphovascular invasion (LVI) was the strongest independent predictor of micrometastatic disease.
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