Prognostic factors in invasive squamous cell carcinoma of the penis: analysis of 196 patients treated at the Brazilian National Cancer Institute.

PURPOSE: We evaluated the role of primary tumor histopathological features for predicting regional metastasis and the prognosis in patients with penile squamous cell carcinoma.

MATERIALS AND METHODS: From April 1996 to January 2007, 202 consecutive patients with penile carcinoma underwent surgical treatment at our institution. Of these patients 196 were studied to identify prognostic factors. All histological specimens were examined by the same pathologist. We considered certain histological parameters, including histological grade, invasion depth, lymphovascular embolization, perineural infiltration, infiltration of the corpus cavernosum or spongiosum, urethral infiltration and koilocytosis.

RESULTS: Variables significantly associated with regional metastasis on univariate analysis were stage stratification (p = 0.0338), histological grade (p = 0.0112), invasion depth (0.0114), lymphovascular embolization (p <0.0001), perineural infiltration (p = 0.0092), corpora cavernosa infiltration (p = 0.0005) and koilocytosis (p = 0.0013). In the multivariable model lymphovascular embolization and absent koilocytosis were independent risk factors for lymphatic metastasis (p = 0.001 and 0.009, respectively). We also found a better survival rate in patients with koilocytosis and without lymphovascular embolization (p = 0.001 and 0.005, respectively).

CONCLUSIONS: Lymphovascular embolization and absent koilocytosis were independent prognostic factors for the risk of lymphatic metastasis. Patients with koilocytosis and without lymphovascular embolization had better 5-year survival.