Pd51-09 survival in n3 penile cancer: does pelvic lymphadenopathy predict a worse prognosis than inguinal extra-nodal extension?

You have accessJournal of UrologyCME1 May 2022PD51-09 SURVIVAL IN N3 PENILE CANCER: DOES PELVIC LYMPHADENOPATHY PREDICT A WORSE PROGNOSIS THAN INGUINAL EXTRA-NODAL EXTENSION? James A. Churchill, Ashwin Sachdeva, Allaudin Issa, Craig Jones, Fowz Azhar, Ikenna Aneke, Noel W. Clarke, Maurice W. Lau, Vijay K. Sangar, and Arie S. Parnham James A. ChurchillJames A. Churchill More articles by this author , Ashwin SachdevaAshwin Sachdeva More articles by this author , Allaudin IssaAllaudin Issa More articles by this author , Craig JonesCraig Jones More articles by this author , Fowz AzharFowz Azhar More articles by this author , Ikenna AnekeIkenna Aneke More articles by this author , Noel W. ClarkeNoel W. Clarke More articles by this author , Maurice W. LauMaurice W. Lau More articles by this author , Vijay K. SangarVijay K. Sangar More articles by this author , and Arie S. ParnhamArie S. Parnham More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002622.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile squamous cell cancer (PSCC) with lymph node (LN) disease has a poor overall survival (OS). The current TNM classification system defines clinical N3 (cN3) stage as the presence of fixed inguinal LN metastasis or pelvic lymphadenopathy (PLN), and pathologic N3 (pN3) stage as metastasis in pelvic LN and/or extra-nodal extension (ENE) in any LN. This study has examined whether N3 stage can be further stratified based on ENE and PLN status. We hypothesised a worse OS for patients with PLN on cross-sectional imaging compared to those with ENE present in inguinal LN (iENE) and without PLN. METHODS: We analysed retrospective data for patients treated at a UK tertiary referral centre between 2003 and 2021 with PSCC and suspicion of LN disease (cN+) at diagnosis. We excluded patients with extra-pelvic LN or distant metastatic disease at diagnosis and those without available cross-sectional imaging of the abdomen and pelvis within 6 months of definitive primary (penile) treatment. The primary outcome of OS (time from definitive primary surgery to death, censored for last follow-up) was stratified by PLN present (PLN+) vs PLN absent and iENE present (PLN-iENE+). The PLN absent and iENE absent (PLN-iENE-) group has been included as a reference for OS comparison. Audit approval was obtained from the host clinical governance committee. RESULTS: 199 patients met inclusion criteria, of which 110 were categorised as PLN-iENE-, 58 as PLN-iENE+ and 31 as PLN+. Baseline characteristics of age, primary tumour stage and grade were similar across all groups. Univariate Cox regression analysis demonstrated an increased risk of death in the PLN-iENE+ group (HR=2.23, 95% CI 1.38-3.61, p=0.001) and the PLN+ group (HR=4.08, 95% CI 2.39-6.97, p<0.001) compared to the reference PLN-iENE- group (Figure 1). CONCLUSIONS: In patients with PSCC and clinical evidence of LN metastases, the PLN-iENE+ and PLN+ groups show worse OS compared to those with PLN-iENE- as predicted by the current TNM classification system. The results also demonstrate that the presence of PLN predicts worse OS than the presence of iENE. This suggests that the current TNM classification system should be refined by further stratifying the staging groups based on ENE and PLN status. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e845 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information James A. Churchill More articles by this author Ashwin Sachdeva More articles by this author Allaudin Issa More articles by this author Craig Jones More articles by this author Fowz Azhar More articles by this author Ikenna Aneke More articles by this author Noel W. Clarke More articles by this author Maurice W. Lau More articles by this author Vijay K. Sangar More articles by this author Arie S. Parnham More articles by this author Expand All Advertisement PDF downloadLoading ...