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Identifying an optimal lymph node yield for penile squamous cell carcinoma: prognostic impact of surgical dissection
Author(s) -
Chipollini Juan,
Azizi Mounsif,
Lo Vullo Salvatore,
Mariani Luigi,
Zhu Yao,
Ye Ding W.,
Ornellas Antonio Augusto,
Watkin Nick,
Ager Michael,
Hakenberg Oliver,
Heidenreich Axel,
Raggi Daniele,
Catanzaro Mario,
Ornellas Paulo,
Salvioni Roberto,
Cheriyan Salim K.,
Necchi Andrea,
Spiess Phillippe E.
Publication year - 2020
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14883
Subject(s) - interquartile range , penile cancer , medicine , lymph node , proportional hazards model , hazard ratio , lymphadenectomy , urology , dissection (medical) , cohort , retrospective cohort study , survival analysis , surgery , oncology , cancer , confidence interval
Objective To evaluate the prognostic impact of lymph node yield ( LNY ) on survival outcomes for penile squamous cell carcinoma (SCC). Patients and methods In all, 532 patients who underwent inguinal LN dissection ( ILND ) across tertiary referral centres from Europe, China, Brazil and North America were retrospectively evaluated. From this cohort, 198 patients received pelvic LND ( PLND ).We identified threshold values for ILND and PLND using receiver operating characteristic curves. We tested prognostic value of LNY for recurrence‐free survival ( RFS ), disease‐specific survival ( DSS ), and overall survival ( OS ) using the Kaplan–Meir method and Cox proportional hazard regression models. Results The median (interquartile [IQR]) age was 59 (49–68) years and the median (IQR) follow‐up after ILND was 28 (12–68.2) months. Overall, 85% of the patients had bilateral dissections. The median (IQR) number of inguinal LN s removed was 15 (10–22). Of those receiving PLND , The median (IQR) number of LN s was 13 (8–19). A LNY of ≥15 was used for dichotomisation of ILND patients, and a LNY of ≥9 was used in the PLND cohort. Patients with a LNY ≥15 had significantly better 5‐year OS vs patients with a LNY <15 (70.1% vs 58.7%). On multivariable analyses, a LNY ≥15 was a predictor of OS ( hazard ratio [HR] 0.68, P = 0.029). For cN 0 patients, a LNY ≥15 was an independent predictor of RFS ( HR 0.52, P = 0.043) and OS ( HR 0.53, P = 0.021). In the PLND cohort, a LNY ≥9 was a predictor of RFS ( HR 0.53, P = 0.032). Conclusions Using one of the largest LND datasets to date, we found LNY to be a significant predictor of outcomes after lymphatic staging for penile SCC . Prospective validation is warranted.