Abstract
The significance of perineural invasion (PNI) present in penile cancer (PC) is controversial. In order to clarify the predictive role of PNI in the inguinal lymph node (ILN) metastases (ILNM) and oncologic outcome of patients, we performed this meta-analysis and systematic review. The search of PubMed, Embase, and Web of Science was conducted for appropriate studies, up to 20 January 2018. The pooled odds ratio (OR) and hazard ratio (HR) with their 95% confidence interval (CI) were applied to evaluate the difference in ILNM and oncologic outcome between patients present with PNI and those who were absent. A total of 298 in 1001 patients present with PNI were identified in current meta-analysis and systematic review. Significant difference was observed in ILNM between PNI present and absent from patients with PC (OR = 2.98, 95% CI = 2.00–4.45). Patients present with PNI had a worse cancer-specific survival (CSS) (HR = 3.58, 95% CI = 1.70–7.55) and a higher cancer-specific mortality (CSM) (HR = 2.20, 95% CI = 1.06–3.82) than those cases without PNI. This meta-analysis and systematic review demonstrated the predictive role of PNI in ILNM, CSS, and CSM for PC patients.
Highlights
Penile cancer (PC), as a rare malignancy, was estimated to affect approximately 2000 Americans in 2017 [1]
The association between perineural invasion (PNI) and inguinal lymph nodes (ILNs) metastasis (ILNM) was reported by eight studies [5,14,17-21], but one study was excluded from this meta-analysis because of limited data [6]
Another two studies evaluated the role of PNI in cancer-specific survival (CSS) and cancer-specific mortality (CSM) of patients, listing hazard ratio (HR) and its 95% confidence interval (CI) in multivariable Cox regression, respectively
Summary
Penile cancer (PC), as a rare malignancy, was estimated to affect approximately 2000 Americans in 2017 [1]. 5-year survival rate may diminish to 80% in patients with inguinal lymph nodes (ILNs) metastases (ILNM), 0–33% with pelvic lymph nodes (PLNs) involvement [7,8]. Radical ILND leads to approximately 40–70% of patients suffering major or minor complications. Some studies indicated that 30–50% of patients with clinically positive ILNs were treated based on ‘risk factors’ provided by guidelines, such as clinical ILNs status, tumor grade and stage [10,11]. Occult metastases exist in approximately 25% patients with non-palpable nodes and surgical lymph node staging proposed for intermediate (pT1G2) and high risk patients (any T2 or grade 3–4) according to the 2014 European Association of Urology (EAU) guidelines undoubtedly increases the medical expenses and suffering of PC patients [12,13]
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