Christian D Fankhauser1,2,3,4, Hielke M de Vries5,6, Eduard Roussel7, Jakob Kristian Jakobsen8, Allaudin Issa9, Esther W C Lee9, Nicolo Schifano10,11,12, Hussain Alnajjar10,11,12, Fabio Castiglione10,11,12, Luca Antonelli13,14, Pedro Oliveira15, Maurice Lau9, Arie Parnham9, Maarten Albersen7, Nicholas A Watkin16, Asif Muneer10,11,12, Ben E Ayres16, Oscar R Brouwer5,6, Vijay Sangar9,17. 1. Department of Urology, The Christie NHS Foundation Trust, Manchester, UK. cdfankhauser@gmail.com. 2. Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland. cdfankhauser@gmail.com. 3. University of Zurich, Zurich, Switzerland. cdfankhauser@gmail.com. 4. Luzerner Kantonsspital, Luzern, Switzerland. cdfankhauser@gmail.com. 5. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 6. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. 7. Department of Urology, University Hospitals Leuven, Leuven, Belgium. 8. Department of Urology, Aarhus University Hospital, Aarhus, Denmark. 9. Department of Urology, The Christie NHS Foundation Trust, Manchester, UK. 10. NIHR Biomedical Research Centre, University College London Hospital, London, UK. 11. Department of Urology, University College London Hospital, London, UK. 12. Division of Surgery and Interventional Science, UCL, London, UK. 13. Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland. 14. Department of Urology, Policlinico Umberto I, Rome, Italy. 15. Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK. 16. Department of Urology, St George's Hospital, London, UK. 17. Manchester Academic Health Sciences Centre, Manchester, UK.
Abstract
PURPOSE: To analyse the risk of inguinal lymph node (ILN) metastases in T1G2 penile cancer stratified by lymphovascular invasion (LVI), perineural invasion (PNI) and tumour size. METHODS: Retrospective study of men with localised T1G2 penile cancer with non-palpable lymph nodes and no local recurrence during follow-up at six European institutional high-volume centres was performed. ILN involvement was defined as cancer detected during ultrasound-guided fine-needle aspiration cytology, core needle biopsy, dynamic sentinel lymph node biopsy, ILN dissection or inguinal recurrence during follow-up. Uni- and multivariable logistic regression analyses were performed. RESULTS: In the cohort of 554 men with T1G2 penile cancer, from 6 European institutions, ILN metastases were observed in 46/554 men (8%, 95% confidence interval (CI) 6-11%). Men with both, LVI- and PNI- primary cancers had the lowest risk of ILN involvement (6%) whereas men with LVI + or PNI + showed ILN metastases in 22% and 30%. In multivariable regression, men with LVI + or PNI + had higher odds for ILN metastases compared to men with LVI- and PNI- (OR 3.9, 95% CI 1.6-9.0, p value < 0.01) Tumour size was not associated with ILN risk (OR 1.01 95% CI 0.99-1.04, p = 0.17). CONCLUSION: Approximately, one out of ten men with T1G2 overall and one out of four men with either LVI + or PNI + still have ILN metastases despite being clinically node negative. Therefore, invasive ILN staging should strongly be recommended in T1G2 with LVI + or PNI + but importantly, must be discussed in patients with T1G2 with LVI- or PNI-.
PURPOSE: To analyse the risk of inguinal lymph node (ILN) metastases in T1G2 penile cancer stratified by lymphovascular invasion (LVI), perineural invasion (PNI) and tumour size. METHODS: Retrospective study of men with localised T1G2 penile cancer with non-palpable lymph nodes and no local recurrence during follow-up at six European institutional high-volume centres was performed. ILN involvement was defined as cancer detected during ultrasound-guided fine-needle aspiration cytology, core needle biopsy, dynamic sentinel lymph node biopsy, ILN dissection or inguinal recurrence during follow-up. Uni- and multivariable logistic regression analyses were performed. RESULTS: In the cohort of 554 men with T1G2 penile cancer, from 6 European institutions, ILN metastases were observed in 46/554 men (8%, 95% confidence interval (CI) 6-11%). Men with both, LVI- and PNI- primary cancers had the lowest risk of ILN involvement (6%) whereas men with LVI + or PNI + showed ILN metastases in 22% and 30%. In multivariable regression, men with LVI + or PNI + had higher odds for ILN metastases compared to men with LVI- and PNI- (OR 3.9, 95% CI 1.6-9.0, p value < 0.01) Tumour size was not associated with ILN risk (OR 1.01 95% CI 0.99-1.04, p = 0.17). CONCLUSION: Approximately, one out of ten men with T1G2 overall and one out of four men with either LVI + or PNI + still have ILN metastases despite being clinically node negative. Therefore, invasive ILN staging should strongly be recommended in T1G2 with LVI + or PNI + but importantly, must be discussed in patients with T1G2 with LVI- or PNI-.
Authors: Lieke Wever; Hielke M de Vries; Paolo Dell'Oglio; Henk G van der Poel; Maarten L Donswijk; Karolina Sikorska; Fijs W B van Leeuwen; Simon Horenblas; Oscar R Brouwer Journal: BJU Int Date: 2022-03-17 Impact factor: 5.969
Authors: Joost M Blok; Ilse Pluim; Gedske Daugaard; Thomas Wagner; Katarzyna Jóźwiak; Erica A Wilthagen; Leendert H J Looijenga; Richard P Meijer; J L H Ruud Bosch; Simon Horenblas Journal: BJU Int Date: 2020-01-08 Impact factor: 5.588