MP5-10 PROPHYLACTIC PELVIC LYMPH NODE DISSECTION IN PENILE CANCER PATIENTS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 2015MP5-10 PROPHYLACTIC PELVIC LYMPH NODE DISSECTION IN PENILE CANCER PATIENTS Rosa Djajadiningrat, Erik van Werkhoven, and Simon Horenblas Rosa DjajadiningratRosa Djajadiningrat More articles by this author , Erik van WerkhovenErik van Werkhoven More articles by this author , and Simon HorenblasSimon Horenblas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.237AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pelvic lymph node involvement in penile cancer carries a poor prognosis and therefore there is controversy on the curative role of pelvic lymph node dissection (pLND). The EAU guideline recommends performing a prophylactic pLND in patients with inguinal extranodal extension (ENE), in whom the node of Cloquet or more than two inguinal nodes are involved. In daily practice, selecting the right patients for performing a prophylactic pLND concerns patients with inguinal tumor positivity, but without preoperative signs of pelvic lymph node involvement on imaging. Therefore, the aim of this study was to identify characteristics in the inguinal specimen predictive for pelvic lymph node involvement in patients prophylactically treated with pLND i.e. without any preoperative evidence of pelvic lymph node involvement. METHODS All chemonaive consecutive cases treated at our institute with prophylactic pLND were included since 2001. These patients were all treated within a contemporary management protocol. Generalized estimation equation model was used for prediction of pelvic node involvement based on inguinal characteristics. Disease-specific survival (DSS) was calculated with Kaplan-Meier method. RESULTS 79 chemotherapy naive patients (median age 66 years, IQR 60–74) without any preoperative evidence of pelvic disease treated with prophylactic pLND, were included. 24% of patients turned out to have tumor-positive pelvic nodes. Inguinal ENE or ≥2 tumor-positive inguinal nodes were predictive for having tumor-positive pelvic nodes. Five-year DSS in patients with pelvic involvement was 17% (95%CI 6%-42%) versus 62% (95%CI 50%-74%) in patients without pelvic tumor-positivity. CONCLUSIONS Inguinal ENE or ≥2 inguinal tumor-positive lymph nodes are predictive for pelvic tumor-positivity in patients without evidence of pelvic involvement. However DSS remains poor in patients with pelvic node involvement treated with surgery only. New treatment strategies are more than welcome in high risk patients with poor prognosis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e49 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rosa Djajadiningrat More articles by this author Erik van Werkhoven More articles by this author Simon Horenblas More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...