Clinical Outcomes in Clinical N0 Squamous Cell Carcinoma of the Penis According to Nodal Management: Early, Delayed or Selective (following Dynamic Sentinel Node Biopsy) Inguinal Lymph-Node Dissection

No AccessJournal of UrologyAdult Urology1 Aug 2021Clinical Outcomes in Clinical N0 Squamous Cell Carcinoma of the Penis According to Nodal Management: Early, Delayed or Selective (following Dynamic Sentinel Node Biopsy) Inguinal Lymph-Node DissectionThis article is commented on by the following:Editorial CommentEditorial Comment Sebastiano Nazzani, Mario Catanzaro, Davide Biasoni, Marco Maccauro, Carlotta Zaborra, Silvia Stagni, Tullio Torelli, Alberto Macchi, Antonio Tesone, Alice Lorenzoni, Luigi Piva, Rodolfo Lanocita, Maurizio Colecchia, Emanuele Montanari, Roberto Salvioni, Giorgio Pizzocaro, and Nicola Nicolai Sebastiano NazzaniSebastiano Nazzani Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Equal study contribution. More articles by this author , Mario CatanzaroMario Catanzaro Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Equal study contribution. More articles by this author , Davide BiasoniDavide Biasoni Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Financial and/or other relationship with the National Institutes of Health (NIH). More articles by this author , Marco MaccauroMarco Maccauro Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Financial and/or other relationship with the National Institutes of Health (NIH). More articles by this author , Carlotta ZaborraCarlotta Zaborra Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author , Silvia StagniSilvia Stagni Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author , Tullio TorelliTullio Torelli Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author , Alberto MacchiAlberto Macchi Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author , Antonio TesoneAntonio Tesone Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author , Alice LorenzoniAlice Lorenzoni Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author , Luigi PivaLuigi Piva Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author , Rodolfo LanocitaRodolfo Lanocita Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author , Maurizio ColecchiaMaurizio Colecchia Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Milano, Italy More articles by this author , Emanuele MontanariEmanuele Montanari Urology Department, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy More articles by this author , Roberto SalvioniRoberto Salvioni Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author , Giorgio PizzocaroGiorgio Pizzocaro Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Emeritus. More articles by this author , and Nicola NicolaiNicola Nicolai §Correspondence: Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano , Italy (telephone:+39 02 23902163; FAX: +39 0223902708; E-mail Address: [email protected] Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001775AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated the oncologic efficacy of early inguinal lymph-node dissection, observation or dynamic sentinel node biopsy followed by delayed or selective inguinal lymph-node dissection in cN0 patients with penile squamous cell carcinoma. Materials and Methods: Between 1980 and 2017 (inclusive), 296 evaluable consecutive cN0 penile squamous cell carcinoma patients underwent early inguinal lymph-node dissection (16), observation (114) or dynamic sentinel node biopsy (166). Median followup was 50 months. Tumor stage, grade, lympho-vascular invasion and age were considered. Kaplan-Meier plots illustrated 5-year inguinal relapse-free and cancer specific survival rates. Multivariable Cox regression models tested the treatment effect. Analyses were repeated after inverse probability of treatment weighting adjustment. Results: The 5-year inguinal relapse-free survival and cancer specific survival rates following early, observation and dynamic sentinel node biopsy inguinal lymph-node dissection were 100%, 87%, 89%, and 84%, 81%, 85%, respectively. The 5-year crude inguinal relapse-free survival and cancer specific survival rates were 90% and 93% in low-risk patients undergoing observation. Clavien grade 3 complications were 0.6 vs 12.5% in the dynamic sentinel node biopsy and early inguinal lymph-node dissection group, respectively. After inverse probability after treatment weighting adjustment, 5-year inguinal relapse and cancer specific survival were 90% vs 73% and 90% vs 77% following dynamic sentinel node biopsy and observation, respectively. At multivariable Cox regression model, patients undergoing dynamic sentinel node biopsy had significantly lower inguinal relapse (HR 0.4, 95% CI 0.2–0.85, p 0.02) and cancer specific mortality (HR 0.29, 95% CI 0.11–0.77; p=0.01) compared to those under observation. The low number of patients undergoing early inguinal lymph-node dissection made a reliable comparison with this group impractical. Conclusions: Selective inguinal lymph-node dissection following dynamic sentinel node biopsy significantly improved inguinal relapse and cancer specific mortality when compared with observation, providing evidence of efficacy of dynamic sentinel node biopsy in clinical stage N0 squamous cell carcinoma of the penis. References 1. : Penile cancer epidemiology and risk factors: a contemporary review. Curr Opin Urol 2019; 29: 145. Google Scholar 2. : Cancer statistics, 2018. CA Cancer J Clin 2018; 68: 7. Google Scholar 3. : Conservative surgery for squamous cell carcinoma of the penis: resection margins and long-term oncological control. J Urol 2012; 188: 803. Link, Google Scholar 4. : Peniscopically controlled CO2 laser excision for conservative treatment of in situ and T1 penile carcinoma: report on 224 patients. Eur Urol 2008; 54: 875. Google Scholar 5. : pT1 Penile squamous cell carcinoma: a clinicopathologic study of 56 cases treated by CO2 laser therapy. 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Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2021) This Month in Adult UrologyJournal of Urology, VOL. 206, NO. 2, (187-189), Online publication date: 1-Aug-2021.Related articlesJournal of UrologyMay 6, 2021, 12:00:00 AMEditorial CommentJournal of UrologyMay 6, 2021, 12:00:00 AMEditorial Comment Volume 206Issue 2August 2021Page: 354-363Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordssentinel lymph node biopsyrisk factorslymph node excisionpenile neoplasmsMetricsAuthor Information Sebastiano Nazzani Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Equal study contribution. More articles by this author Mario Catanzaro Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Equal study contribution. More articles by this author Davide Biasoni Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Financial and/or other relationship with the National Institutes of Health (NIH). More articles by this author Marco Maccauro Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Financial and/or other relationship with the National Institutes of Health (NIH). More articles by this author Carlotta Zaborra Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Silvia Stagni Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Tullio Torelli Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Alberto Macchi Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Antonio Tesone Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Alice Lorenzoni Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Luigi Piva Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Rodolfo Lanocita Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Maurizio Colecchia Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Milano, Italy More articles by this author Emanuele Montanari Urology Department, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy More articles by this author Roberto Salvioni Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Giorgio Pizzocaro Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Emeritus. More articles by this author Nicola Nicolai Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy §Correspondence: Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano , Italy (telephone:+39 02 23902163; FAX: +39 0223902708; E-mail Address: [email protected] More articles by this author Expand All Advertisement Loading ...