Purpose: To evaluate the number of lymph nodes (LNs) removed, as a performance measure of lymph node dissection (LND), in a population-based database. Materials and Methods: Data from the Surveillance, Epidemiology, and End Results database (1988-2009) were used to identify 393 patients who underwent regional LND for penile cancer. The study cohort was divided into two groups: limited LND (<8 LNs removed) and extensive LND (≥8 LNs removed). Logistic regression analyses were performed to assess factors associated with extensive LND. Log-rank tests were used to evaluate the associations between LN evaluation and survival outcomes. Results: The median number of removed LNs was 15, and 28% of patients underwent limited LND. The prevalence of extensive LND decreased gradually with increasing age: from 81% in men younger than 50 years to 65% in men aged 70 years or older. In multivariate analysis, only age retained an independent association with extensive LND (odds ratio = 0.98, p = 0.01). Log-rank test showed better cause-specific survival in patients receiving extensive LND (p = 0.006). The difference in survival was statistically significant in the subgroup of node-positive penile cancer patients (p = 0.01). Conclusions: An inadequate number of LN retrieval was observed in a considerable proportion of penile cancer patients, especially in the elderly population.

Keywords:
Penile neoplasms, Surveillance, Epidemiology, and End Results program, Lymph node excision, Multivariate analysis
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