Introduction: Penile cancer is rare, and data on prognostic factors of the disease are scarce. The aim of the study was to assess prognostic factors in patients undergoing lymphadenectomy for penile cancer. Material and Methods: Ninety-eight men who underwent lymphadenectomy for penile cancer were enrolled in the study. Progression-free survival and overall survival were assessed. Results: Five-year progression-free survival and overall survival were 0.6651 (95% CI: 0.5151-0.7783) and 0.5516 (95% CI: 0.4412-0.6488), respectively. Multivariate analysis showed that the factors that reduce progression-free survival include delay of lymphadenectomy by more than 3 months after diagnosis (p = 0.045) and involvement of non-inguinal lymph nodes (N0 vs. affected lymph nodes other than superficial inguinal, p = 0.0004; superficial inguinal vs. others, p = 0.001). Factors deteriorating overall survival include high grade (G1 vs. G2, p = 0.0072, and G1 vs. G3, p = 0.0347), more than one lymph node affected (p = 0.001) and crossing the lymph node capsule (p = 0.034). Conclusions: The factors worsening the prognosis in patients with penile cancer after lymphadenectomy include delayed lymphadenectomy, involvement of lymph nodes other than the superficial inguinal, involvement of more than one lymph node, crossing the lymph node capsule, and high grade.

1.
Wojciechowska U, Didkowska J, Zatoński W: Cancer in Poland 2008. Warsaw, National Cancer Control Programme, 2010.
2.
Barnholtz-Sloan JS, Maldonado JL, Pow-sang J, Giuliano AR: Incidence trends in primary malignant penile cancer. Urol Oncol 2007;25:361-367.
3.
European Network of Cancer Registries. Eurocim version 4.0. European incidence database V2.2 (1999). Lyon, IARC, 2001.
4.
Parkin DM, Whelan SL, Ferlay J: Cancer Incidence in Five Continents. Lyon, IARC, No 155, vol VIII, 2002.
5.
Burgers JK, Badalament RA, Drago JR: Penile cancer. Clinical presentation, diagnosis, and staging. Urol Clin North Am 1992;19:247-256.
6.
Cabanas RM: Anatomy and biopsy of sentinel lymph nodes. Urol Clin North Am 1992;19:267-276.
7.
Parra RO: Accurate staging of carcinoma of the penis in men with nonpalpable inguinal lymph nodes by modified inguinal lymphadenectomy. J Urol 1996;155:560-563.
8.
National Comprehensive Cancer Network (NCCN): Penile Cancer. NCCN Clinical Practice Guidelines in Oncology vI.2012.
9.
Pizzocaro G, Algaba F, Horenblas S, Solsona E, Tana S, Van Der Poel H, Watkin NA, European Association of Urology (EAU) Guidelines Group on Penile Cancer: EAU Penile Cancer Guidelines 2009. Eur Urol 2010;57:1002-1012.
10.
Ayyappan K, Ananthakrishnan N, Sankaran V: Can regional lymph node involvement be predicted in patients with carcinoma of the penis? Br J Urol 1994;73:549-553.
11.
Kulkarni JN, Kamat MR: Prophylactic bilateral groin node dissection versus prophylactic radiotherapy and surveillance in patients with N0 and N1-2A carcinoma of the penis. Eur Urol 1994;26:123-128.
12.
Lopes A, Rossi BM, Fonseca FP, Morini S: Unreliability of modified inguinal lymphadenectomy for clinical staging of penile carcinoma. Cancer 1996;77:2099-2102.
13.
Villavicencio H, Rubio-Briones J, Regalado R, Chechile G, Algaba F, Palou J: Grade, local stage and growth pattern as prognostic factors in carcinoma of the penis. Eur Urol 1997;32:442-447.
14.
Zhu Y, Zhang HL, Yao XD, Zhang SL, Dai B, Shen YJ, Ye DW: Development and evaluation of a nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes. J Urol 2010;184:539-545.
15.
Graafland NM, Moonen LM, van Boven HH, van Werkhoven E, Kerst JM, Horenblas S: Inguinal recurrence following therapeutic lymphadenectomy for node positive penile carcinoma: outcome and implications for management. J Urol 2011;185:888-893.
16.
Leijte JA, Hughes B, Graafland NM, Kroon BK, Olmos RA, Nieweg OE, Corbishley C, Heenan S, Watkin N, Horenblas S: Two-center evaluation of dynamic sentinel node biopsy for squamous cell carcinoma of the penis. J Clin Oncol 2009;27:3325-3329.
17.
Ornellas AA, Kinchin EW, Nóbrega BL, Wisnescky A, Koifman N, Quirino R: Surgical treatment of invasive squamous cell carcinoma of the penis: Brazilian National Cancer Institute long-term experience. J Surg Oncol 2008;97:487-495.
18.
Hughes BE, Leijte JA, Kroon BK, Shabbir MA, Swallow TW, Heenan SD, Corbishley CM, van Boven HH, Perry MJ, Watkin NA, Horenblas S: Lymph node metastasis in intermediate-risk penile squamous cell cancer: a two-centre experience. Eur Urol 2010;57:688-692.
19.
Pizzocaro G, Algaba F, Solsona E, Tana S, Van Der Poel H, Watkin N, Horenblas S: Guidelines on Penile Cancer. Arnhem, European Association of Urology, 2012.
20.
Horenblas S: Lymphadenectomy for squamous cell carcinoma of the penis. 2. The role and technique of lymph node dissection. BJU Int 2001;88:473-483.
21.
Yamada Y, Gohji K, Hara I: Long-term follow-up study of penile cancer. Int J Urol 1998;5:247-251.
22.
Kroon BK, Horenblas S, Lont AP, Tanis PJ, Gallee MP, Nieweg OE: Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol 2005;173:816-819.
23.
Lont AP, Kroon BK, Gallee MP, van Tinteren H, Moonen LM, Horenblas S: Pelvic lymph node dissection for penile carcinoma: extent of inguinal lymph node involvement as an indicator for pelvic lymph node involvement and survival. J Urol 2007;177:947-952.
24.
Svatek RS, Munsell M, Kincaid JM, Hegarty P, Slaton JW, Busby JE, Gaston KE, Spiess PE, Pagliaro LC, Tamboli P, Pettaway CA: Association between lymph node density and disease specific survival in patients with penile cancer. J Urol 2009;182:2721-2727.
25.
Franks KN, Kancherla K, Sethugavalar B, Whelan P, Eardley I, Kiltie AE: Radiotherapy for node positive penile cancer: experience of the Leeds teaching hospitals. J Urol 2011;186:524-529.
26.
National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Penile Cancer. NCCN Guidelines v1.2013.
27.
Pizzocaro G, Piva L: Adjuvant and neoadjuvant vincristine, bleomycin, and methotrexate for inguinal metastases from squamous cell carcinoma of the penis. Acta Oncol 1988;27:823-824.
28.
Pagliaro LC, Williams DL, Daliani D, Williams MB, Osai W, Kincaid M, Wen S, Thall PF, Pettaway CA: Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy for metastatic penile cancer: a phase II study. J Clin Oncol 2010;28:3851-3857.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.