Prophylactic pelvic lymph node dissection in patients with penile cancer.

PURPOSE: Pelvic lymph node involvement in penile cancer carries a poor prognosis. Therefore, there is controversy about the curative role of pelvic lymph node dissection. We analyzed the characteristics of tumor positive inguinal regions predictive for pelvic lymph node involvement in patients prophylactically treated with pelvic lymph node dissection.

MATERIALS AND METHODS: All chemonaïve consecutive cases treated with prophylactic pelvic lymph node dissection at our institution since 2001 were included in analysis. A generalized estimating equation model was used to predict pelvic node involvement based on inguinal characteristics. Disease specific survival was calculated with the Kaplan-Meier method.

RESULTS: Included in study were 79 chemotherapy naïve patients without preoperative evidence of pelvic disease who were treated with prophylactic pelvic lymph node dissection. Pelvic nodes were positive in 24% of the patients. Inguinal extranodal extension, or 2 or more tumor positive nodes were predictive of tumor positive pelvic nodes. The 5-year disease specific survival rate in patients with pelvic involvement was 17%.

CONCLUSIONS: Inguinal extranodal extension, or 2 or more inguinal tumor positive lymph nodes are predictive of pelvic tumor positivity in patients without evidence of pelvic involvement. However, disease specific survival remains poor in patients with pelvic node involvement who are treated with surgery only.