Penile Cancer Patients Research Articles

Laser ablation as monotherapy for penile squamous cell carcinoma: A multi-center cohort analysis

IntroductionAlthough the trend towards penile sparing therapy is increasing for penile squamous cell carcinoma, outcomes for laser ablation therapy have not been widely reported. We assessed the clinical outcomes of penile cancer patients treated with only laser ablation. Materials and methodsA retrospective review was performed on 161 patients across 5 multi-center tertiary referral centers from 1985 to 2015. All patients underwent penile sparing surgery with only laser ablation for squamous cell carcinoma of the penis. Laser ablation was performed with neodymium-doped yttrium aluminum garnet or carbon dioxide. Overall and recurrence-free survival was calculated using the Kaplan-Meier method and compared with the log rank test. ResultsA total of 161 patients underwent laser ablation for penile cancer. The median age was 62 (IQR: 52–71) years and median follow-up was 57.7 (IQR: 28–90) months. The majority of patients were pTa/Tis (59, 37%) or pT1a (62, 39%). Only 19 (12%) had a poorly differentiated grade. The 5-year recurrence-free survival was 46%. When stratified by stage, the 5-year local recurrence-free survival was pTa/Tis: 50%; pT1a: 41%; pT1b: 38%; and pT2: 52%. The inguinal/pelvic nodal recurrence was pTa/Tis: 2%; pT1a: 5%; pT1b: 18%; and pT2: 22%. There were no differences among stages with respect to recurrence-free survival (P = 0.98) or overall survival (P = 0.20). ConclusionLaser ablation therapy is safe for appropriately selected patients with penile squamous cell carcinoma. Due to the increased risk of nodal recurrence, laser ablation coupled with diagnostic nodal staging is indicated for patients with pT1b or higher.

Clinical scenarios for neoadjuvant chemotherapy of squamous penile cancer that is clinically node positive.

Squamous penile cancer may be localized to the phallus, metastatic to regional lymph nodes, or metastatic to distant lymph nodes or other organs. In the clinical situation of regional lymph node metastasis, a multimodality approach can have a big impact on outcomes. In particular, use of systemic chemotherapy as a neoadjuvant treatment is discussed, with several examples illustrating instances of regression and of resistance, and contrasting with adjuvant timing for use of chemotherapy. Radiation with coordinated combined chemotherapy is another complementary, locally directed approach that can be considered for men with squamous penile cancer with regional lymph node spread. The randomized trial InPACT (International Penile Cancer Adjuvant Chemotherapy Trial, NCT02305654) will enroll some of the squamous penile cancer patients with clinically node positive disease.

Postchemotherapy lymph node dissection for isolated retroperitoneal nodal recurrences for penile cancer: Is cure possible in highly selected cases?

Outcomes for advanced penile carcinoma remain poor with limited options for curative treatment. Nodal recurrences represent worse prognosis and are typically treated with a combination of radiation, chemotherapy, or consolidative resection. Although the ideal management for recurrences remains unknown, there is some evidence supporting the role of chemotherapy followed by consolidative resection. Using a multimodal strategy, we describe the curative potential of postchemotherapy retroperitoneal lymph node dissection for penile cancer patients with isolated locoregional recurrences in the retroperitoneum.

Identifying Psychosocial Distress and Stressors Using Distress-screening Instruments in Patients With Localized and Advanced Penile Cancer.

We examined the effects of treatment on the psychological well-being of patients with localized or advanced penile cancer using screening questionnaires to determine the consecutive need for psychosocial care. Penile cancer is a rare, but highly aggressive, malignancy. The psychological stress of patients with penile cancer arises from the cancer diagnosis per se and the corresponding consequences of treatment. In addition, cancer-specific distress results (eg, fear of metastasis, progression, relapse, death). Studies of the psychosocial stress of penile cancer patients are rare. We undertook a prospective analysis of the data from patients with penile cancer who had undergone surgery or chemotherapy from August 2014 to October 2016 at our department. Patients were evaluated using standardized questionnaires for stress screening and the identification for the need for psychosocial care (National Comprehensive Cancer Network Distress Thermometer and Hornheider screening instrument) and by assessing the actual use of psychosocial support. The average stress level was 4.5. Of all the patients, 42.5% showed increased care needs at the time of the survey. Younger patients, patients undergoing chemotherapy, and patients with recurrence were significantly more integrated with the psychosocial care systems. Finally, 67% of all patients received inpatient psychosocial care. Owing to the potentially mutilating surgery, patients with penile cancer experience increased psychological stress and, consequently, have an increased need for psychosocial care. Therefore, the emotional stress of these patients should be recognized and support based on interdisciplinary collaboration offered.

MP18-10 COMPARISON OF PLANAR SCINTIGRAPHY AND SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY /COMPUTED TOMOGRAPHY (SPECT/CT) IN PREOPERATIVE IMAGING OF SENTINEL LYMPH NODES IN PENILE CANCER PATIENTS

You have accessJournal of UrologyImaging/Radiology: Uroradiology III1 Apr 2017MP18-10 COMPARISON OF PLANAR SCINTIGRAPHY AND SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY /COMPUTED TOMOGRAPHY (SPECT/CT) IN PREOPERATIVE IMAGING OF SENTINEL LYMPH NODES IN PENILE CANCER PATIENTS Carsten Maik Naumann, Moritz Franz Hamann, Christian Colberg, Klaus-Peter Jünemann, Daniar Osmonov, and Ulf Lützen Carsten Maik NaumannCarsten Maik Naumann More articles by this author , Moritz Franz HamannMoritz Franz Hamann More articles by this author , Christian ColbergChristian Colberg More articles by this author , Klaus-Peter JünemannKlaus-Peter Jünemann More articles by this author , Daniar OsmonovDaniar Osmonov More articles by this author , and Ulf LützenUlf Lützen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.620AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study was to evaluate the diagnostic value of SPECT/CT and planar lymphoscintigraphy in preoperative imaging of sentinel lymph nodes in penile cancer patients with non-palpable inguinal lymph nodes. METHODS Radio-labelling of sentinel nodes was performed by intradermal and peritumoral injection of 150MBq Tc-99 m-labelled nanocolloids according to the two day protocol. Image acquisition of planar scintigraphies was carried out by a twin head gamma camera (Siemens, ECAM and Symbia S) and indirect body contouring. Additionally, we subsequently performed SPECT/CT of the abdomen und inguinal regions using a twin-head hybrid camera system (Siemens Symbia T and Symbia Intevo). Imaging data of both modalities were prospectively evaluated by two experienced physicians in consensus reading in 52 groins of 26 patients with this tumor entity. RESULTS A total of 71 SLNs in 37 groins were identified by planar scintigraphy. Non-visualization was observed in 15 (28.8%) inguinal basins using planar scans. 82 SLNs in 42 groins were detected by SPECT/CT (non-visualization in 10 (19.2%) groins). SPECT/CT revealed 8 inguinal hotspots as shown by planar imaging in 7 groins as false positive. 19 inguinal SLNs in 16 groins were missed on planar imaging and could be detected by SPECT/CT only. In contrast to 2D planar scintigraphy, SPECT/CT allowed to determine the precise anatomical localization of the SLNs in all 42 groins. CONCLUSIONS SPECT/CT is capable of detecting SLNs missed by planar imaging, it reduces the number of false positive findings and shows the morphological location of SLNs more accurately. If available, SPECT/CT should be used for preoperative SLN imaging in penile cancer patients with non-palpable inguinal lymph node status. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e223-e224 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Carsten Maik Naumann More articles by this author Moritz Franz Hamann More articles by this author Christian Colberg More articles by this author Klaus-Peter Jünemann More articles by this author Daniar Osmonov More articles by this author Ulf Lützen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD49-02 PREDICTION OF POSTOPERATIVE COMPLICATIONS AFTER INGUINAL LYMPHADENECTOMY FOR PENILE CANCER USING A NOVEL CLASSIFICATION TOOL

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease I1 Apr 2017PD49-02 PREDICTION OF POSTOPERATIVE COMPLICATIONS AFTER INGUINAL LYMPHADENECTOMY FOR PENILE CANCER USING A NOVEL CLASSIFICATION TOOL Yao Zhu, Wei-Jie Gu, Philippe Spiess, and Ding-Wei Ye Yao ZhuYao Zhu More articles by this author , Wei-Jie GuWei-Jie Gu More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , and Ding-Wei YeDing-Wei Ye More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2226AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To develop and validate a preoperative radiological assessment tool for predicting complications following inguinal lymph node dissection (ILND) in penile cancer patients. METHODS Patients treated at Fudan University Shanghai Cancer Center (n=175) and Moffitt Cancer Center (n=28) were used for prediction assessment and repetition, respectively. The ILN complexity score (ILCS) included 5 radiological features of ILNs and surrounding adipose tissue. A tertiary (low/moderate/high) classification was assigned according to the sum score. Postoperative complications were graded according to the Clavien-Dindo system. Logistic regression analyses were used to assess the odd ratios (ORs) of the ILCS for predicting overall and major (grade=2) complications. RESULTS In the primary cohort, overall and major complications were observed in 47.4% and 20.5% of patients, respectively. Controlling for covariates, the moderate and high scores had 2.73 (p=0.02) and 4.61-fold (p=0.01) increased risks of overall complications compared with the low score. For predicting major complications, the adjusted OR was 3.48 for the moderate score (p=0.02), and 17.01 for the high score (p<0.01), using the low score as a reference. The predictive accuracy of the ILCS for overall and major complications was 0.63 (0.56-0.70) and 0.73 (0.64-0.82), respectively. In the repetition cohort, the ILCS was significantly associated with major complications (OR=17.33, p=0.02) and showed a predictive accuracy of 0.79 (0.64-0.93). CONCLUSIONS Using structured radiological measurements of the inguinal nodal basin, the ILCS provided accurate risk estimation of overall and major complications after ILND for penile cancer. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e973-e974 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yao Zhu More articles by this author Wei-Jie Gu More articles by this author Philippe Spiess More articles by this author Ding-Wei Ye More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP80-19 TREATMENT TRENDS AND OUTCOMES FOR LYMPH NODE POSITIVE PENILE CANCER PATIENTS

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease III1 Apr 2017MP80-19 TREATMENT TRENDS AND OUTCOMES FOR LYMPH NODE POSITIVE PENILE CANCER PATIENTS Shreyas Joshi, Handorf Elizabeth, Andres Correa, Michael Haifler, Benjamin Ristau, Robert Uzzo, Richard Greenberg, David Chen, Rosalia Viterbo, Alexander Kutikov, Marc Smaldone, and Daniel Geynisman Shreyas JoshiShreyas Joshi More articles by this author , Handorf ElizabethHandorf Elizabeth More articles by this author , Andres CorreaAndres Correa More articles by this author , Michael HaiflerMichael Haifler More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , David ChenDavid Chen More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , and Daniel GeynismanDaniel Geynisman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2524AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile cancer is an uncommon disease with little level I evidence to guide therapy. The NCCN guidelines advocate a lymph node dissection (LND) with consideration of perioperative chemotherapy (CT) for all lymph node positive (LN+) penile cancer (PC) pts. Using a large national cancer registry, we assessed temporal trends in utilization of CT for LN+M0 PC, and evaluated outcomes between those who did (LND+) and did not (LND-) receive a LND and/or chemotherapy (CT+ vs. CT-). METHODS The National Cancer Database (NCDB) was queried for all non-metastatic PC patients with LN+ squamous cell carcinoma of the penis from 2004-2014. Temporal trends were assessed using Cochran-Armitage tests. Adjusting for patient, clinical, and tumor characteristics, multivariable logistic models were used to examine the association between clinicopathologic characteristics and receipt of CT. Kaplan Meier analyses with log-rank tests and multivariable Cox regressions were used to analyze overall survival (OS). RESULTS Of 1123 pts identified, 750 (67%) underwent a LND. Receipt of chemotherapy was similar in both LND+ (40%) and LND- (42%) pts (p=0.53). From 2004-2014, the overall utilization of systemic therapy significantly increased (38% vs. 48%. p=0.0009). However, only 53% of N3 patients received CT (N1 31%, N2 40%). Following adjustment, older patients (76 + years: OR 0.34 [CI 0.19-0.59], p=0.0002) were less likely to receive CT, while N2 (OR 1.62 [CI 1.16-2.27], p=0.005) and N3 (OR 2.32 [CI 1.67-3.22], p<0.0001) pts were more likely to receive CT. High volume centers (≥ 4 cases of PC/year; 29% of all LN+ cases) delivered less CT (OR 0.69 [CI 0.48-1.00], p=0.047). OS varied from 14.9 mo in the LND-/CT- group to 42.6 mo in the LND+/CT+ group. On multivariable analysis, receipt of CT was not associated with OS (HR 0.95 [CI 0.77-1.19], p=0.67). CONCLUSIONS In hospitals reporting to the NCDB, only 67% of LN+ PC pts receive a LND. While CT utilization has increased since 2004, rates remain low, even for N3 pts for whom the NCCN clearly recommends systemic therapy. Surprisingly, high volume centers were less likely to deliver CT for LN+ patients. Receipt of CT does not appear to affect OS, which likely reflects the aggressive natural history of PC. Nonetheless, these data highlight opportunities to improve adherence to guideline-recommended care. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1088 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Shreyas Joshi More articles by this author Handorf Elizabeth More articles by this author Andres Correa More articles by this author Michael Haifler More articles by this author Benjamin Ristau More articles by this author Robert Uzzo More articles by this author Richard Greenberg More articles by this author David Chen More articles by this author Rosalia Viterbo More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Daniel Geynisman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD49-09 SURVIVAL ANALYSIS OF PATIENTS WITH T2 PENILE CANCER WHO RECEIVED INGUINAL LYMPH NODE DISSECTION: RESULTS FROM THE NATIONAL CANCER DATABASE

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease I1 Apr 2017PD49-09 SURVIVAL ANALYSIS OF PATIENTS WITH T2 PENILE CANCER WHO RECEIVED INGUINAL LYMPH NODE DISSECTION: RESULTS FROM THE NATIONAL CANCER DATABASE Andres Correa, Elizabeth Handorf, Benjamin Ristau, Haifler Haifler, Shreyas Joshi, Robert Uzzo, Rosalia Viterbo, Richard Greenberg, David Chen, Alexander Kutikov, Daniel Geynisman, and Marc Smaldone Andres CorreaAndres Correa More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , Haifler HaiflerHaifler Haifler More articles by this author , Shreyas JoshiShreyas Joshi More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , David ChenDavid Chen More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Daniel GeynismanDaniel Geynisman More articles by this author , and Marc SmaldoneMarc Smaldone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2233AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile cancer (PC) is an uncommon disease with little level I evidence to guide therapy. The NCCN guidelines advocate for inguinal lymph node dissection (LND) for all patients with pT2 disease. Using a large national cancer registry, we assessed temporal trends in LND performance for patients with T2 disease, and evaluated survival outcomes between those who underwent LND and those who did not. METHODS The National Cancer Database (NCDB) was queried for all non-metastatic PC patients with T2 squamous cell carcinoma of the penis from 2004-2014. Temporal trends for receipt of LND were assessed using Cochran-Armitage tests. , We used multivariable logistic regression models to examine the association between demographic and clinicopathologic characteristics and receipt of LND. Kaplan Meier analyses with log-rank tests and multivariable Cox regressions with time-varying covariates were used to assess overall survival (OS). RESULTS A total of 1699 patients met inclusion criteria, of which 617 (36.3%) underwent LND. LND rates increased significantly from 2004 to 2014 (27 versus 46%, p<0.001). Significant differences in rates of LND were observed with regards to receipt of radiation (59% in treated vs 34% in not treated, p<0.001) chemotherapy (69% in treated vs 33% in not treated, p< 0.001), age (53% for =50 yrs vs 22% for >70 yrs, p<0.001), and facility type (21% at community hospitals vs 48% at academic centers, p < 0.001). Following adjustment, the likelihood of receiving of LND decreased with increasing age (71 + year OR 0.30 [CI 0.23-0.64]), and increased with year of diagnosis (OR 2.30 for 2014 vs 2004[CI 1.19-4.43]) and treatment in an academic/research facility (OR 2.92 [CI 1.84-4.62] ). In survival analyses, patients receiving LND had a significantly longer median overall survival (113.9 months vs. 46.2 months, p<0.001). The survival benefit of LND was stronger 2+ years from surgery (HR 0.62 [CI 0.44-0.89]) compared 0-2 years (HR 0.85 [CI 0.68-1.06]) (see figure 1). CONCLUSIONS In hospitals reporting to NCDB, the rate of LND for patients with T2 penile cancer was only 36.3%. The observed survival benefit indicates that LND utilization is an important quality metric in patients with invasive penile cancer. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e977 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Andres Correa More articles by this author Elizabeth Handorf More articles by this author Benjamin Ristau More articles by this author Haifler Haifler More articles by this author Shreyas Joshi More articles by this author Robert Uzzo More articles by this author Rosalia Viterbo More articles by this author Richard Greenberg More articles by this author David Chen More articles by this author Alexander Kutikov More articles by this author Daniel Geynisman More articles by this author Marc Smaldone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

E2F1 Signalling is Predictive of Chemoresistance and Lymphogenic Metastasis in Penile Cancer: A Pilot Functional Study Reveals New Prognostic Biomarkers

BackgroundFor penile cancer (PC) there are no known molecular predictors of lymphatic spread and/or chemoresistance. ObjectiveTo identify functional biomarkers that can predict malignant progression and treatment responsiveness. Design, setting, and participantsWe used four patient-derived PC cell lines and measured invasion and capillary tube formation, chemoresponsiveness, and mRNA and protein expression. Data were further validated in E2F1 transcription factor knockdown and overexpression experiments. We quantified E2F1 transcript levels in a set of nonmetastatic tumours (NM), metastasised primary tumours (PT), and lymph node metastases (M) from 24 patients. E2F1 immunohistochemistry was performed in another set of 13 PC biopsies. Outcome measurements and statistical analysisRelationships between different parameters were analysed using Student t tests. Transcript levels in patient samples were compared using Mann-Whitney U tests. Significance was set at p<0.05. Results and limitationsIn cell lines established from lymph node metastases, E2F1 was more abundantly expressed, pRB was inactivated, and CDK2, CDK4, and cyclins D and E were elevated in comparison to cells from primary PC. Overexpression of E2F1 enhanced migratory capacity and lymphatic endothelial tubule formation, while depletion reduced invasiveness and increased chemosensitivity. VEGFR-3 and VEGF-C and mesenchymal markers were upregulated by high E2F1. E2F1 was clearly upregulated in infiltrative and metastatic primary tumours and metastases (NM vs PT, p<0.05; NM vs M, p<0.0005). E2F1 Quick scores increased from grade I to grade III tumours. A limitation of the study is the small number of patients. ConclusionsE2F1 is a driver of invasion and lymphatic dissemination and promotes chemoresistance. E2F1-related biomarkers might assist in stratifying PC patients for different treatment regimens. Patient summaryThe availability of penile cancer cell lines allows molecular research on the mechanisms underlying metastasis and chemotherapy. A critical pathway involved in both features has been identified and may lead to better patient stratification for treatment selection.

Is sarcopenia a useful prognostic indicator in patients with squamous cell carcinoma of the penis?

426 Background: Sarcopenia is a decrease in skeletal muscle mass and is a quantifiable marker of frailty associated with poor oncological outcomes. Currently there are no studies using sarcopenia as a prognostic indicator for patients with penile cancer. This study investigated the association of sarcopenia with mortality and morbidity outcomes in penile cancer patients in a specialist centre. Methods: A retrospective case-controlled study was performed. Patient cohort comprised 50 patients with metastatic penile cancer ( &gt; pN2 disease) and 50 patients with non-metastatic disease (N0) ; minimum follow-up period of 2 years. Sarcopenia was classified as a skeletal muscle index &lt; 55cm2/m2 and was measured using software and CT imaging. Results: Sarcopenia was present in 31% of our cohort (n = 100). A univariate analysis showed a statistically significant association between the following parameters and patient mortality; sarcopenia (p = 0.005), metastatic disease (p = 0.001), tumour stage (p = 0.001), sarcomatoid squamous cell carcinoma (p = 0.009), CIS (p = 0.034), lymphovascular invasion (LVI) (p = 0.001) and perineural invasion (p = 0.002). Logistic regression analysis found an association between mortality and sarcopenia (p = 0.035) and metastatic disease (p = 0.000) and approached statistical significance with LVI (p = 0.061). Subdividing our cohort into metastatic and non-metastatic groups, showed that sarcopenia was associated with mortality in patients with metastatic disease but was not associated with post-operative complications or chemo-radiotherapy toxicity. Interestingly, sarcopenia was associated with post-operative infection in patients undergoing surgery for non-metastatic disease (p = 0.027). Additionally, for every day remaining in hospital after the 4th post-operative day, there was a 1.275 increase in the risk of death in patients with sarcopenia. Conclusions: Sarcopenia has a potential role as a novel prognostic indicator and could be used as a risk stratification tool in patients with metastatic penile cancer when deciding treatment options. By identifying this subgroup, additional nutritional support and a supervised exercise program can be implemented to improve the morbidity rate.

Outcomes for patients with advanced N3 penile cancer undergoing flap reconstruction and adjuvant chemo/radiotherapy.

419 Background: Patients presenting with advanced penile cancer with significant inguinal disease requiring extensive resection. Reconstruction is required to cover the defect and protect underlying vascular structures when undergoingl adjuvant treatment. Often the performance status or the extent of the disease makes neoadjuvant chemo/radiotherapy difficult. Although this group of patients undoubtedly have a poor prognosis, palliative resection reduces the tumour burden and allows improved wound management and quality of life. The aim of this study was to present the techniques and report the outcomes for patients with N3 disease undergoing flap reconstruction. Methods: Medical records were reviewed for penile cancer patients with fixed inguinal nodal disease either at presentation or recurrence. Resection was performed by a team comprising urological and plastic surgeons. Cancer specific survival and the impact of adjuvant chemo/radiotherapy was recorded. Results: Seventeen patients were included; mean age 62 (range 37–85) years. Nine (53%) patients had a first presentation with penile cancer and advanced nodal disease, with 8 (47%) presenting with inguinal disease recurrence. The majority (n = 13) underwent a vertical rectus abdominis musculocutaneous (VRAM) flap. Of these, 3 required femoral vein reconstruction. Where defects were smaller, a tensor fascia latae (n = 2) or a scrotal advancement flap was used (n = 1). The average length of stay was 23 days (10-45 days) regardless of type of flap. Ten patients had adjuvant radiotherapy, 5 underwent neoadjuvant chemotherapy with a 4 undergoing adjuvant chemotherapy. The disease specific survival was 595 days (range 24-3881). Complications were related to wound healing and managed conservatively. Post operative lower limb lymphoedema occurred in the majority of patients. There were no flap failures and all but one patient was discharged home. Conclusions: Aggressive surgical management for patients with extensive nodal disease and flap reconstruction is feasible. This aids wound management and improves the quality of life for patients. Survival rates can extend to over 12 months following adjuvant treatment.

Investigating the role of SPECT/CT in dynamic sentinel lymph node biopsy for penile cancers

PurposeCurrently, most centres use 2-D planar lymphoscintigraphy when performing dynamic sentinel lymph node biopsy in penile cancer patients with clinically impalpable inguinal nodes. This study aimed to investigate the role of SPECT/CT following 2-D planar lymphoscintigraphy (dynamic and static) in the detection and localization of sentinel lymph nodes in the groin.MethodsA qualitative (visual) review was performed on planar followed by SPECT/CT lymphoscintigraphy in 115 consecutive patients (age 28–86 years) who underwent injection of 99mTc-nanocolloid followed by immediate acquisition of dynamic (20 min) and early static scans (5 min) initially and further delayed static (5 min) images at 120 min followed by SPECT/CT imaging. The lymph nodes detected in each groin on planar lymphoscintigraphy and SPECT/CT were compared.ResultsA total of 440 and 467 nodes were identified on planar scintigraphy and SPECT/CT, respectively. Overall, SPECT/CT confirmed the findings of planar imaging in 28/115 cases (24%). In the remaining 87 cases (76%), gross discrepancies were observed between planar and SPECT/CT images. SPECT/CT identified 17 instances of skin contamination (16 patients, 13%) and 36 instances of in-transit lymphatic tract activity (24 patients, 20%) that had been interpreted as tracer-avid lymph nodes on planar imaging. In addition, SPECT/CT identified 53 tracer-avid nodes in 48 patients (42%) that were not visualized on planar imaging and led to reclassification of the drainage basins (pelvic/inguinal) of 27 tracer-avid nodes.ConclusionsThe addition of SPECT/CT improved the rate of detection of true tracer-avid lymph nodes and delineated their precise (3-D) anatomic localization in drainage basins.

Dynamic sentinel node biopsy for penile cancer: an initial experience in an Irish Hospital.

The presence of nodal metastases is the single most important prognostic factor in penile cancer. However, reliable assessment of nodal status in clinically node-negative (cN0) patients poses a challenge. Approximately 20% of these patients harbour occult nodal metastases. Currently available non-invasive radiological investigations are unreliable in excluding micrometastatic disease. Dynamic sentinel node biopsy (DSNB) is a minimally invasive procedure for assessing lymph node involvement. We report our initial experience with DSNB in assessing the status of regional lymph nodes in cN0 penile cancer patients. DSNB was performed in penile cancer patients with at least one cN0 groin. All patients undergoing DSNB at our institution were included. Lymphoscintigraphic images were obtained from all patients, after intradermal, peritumoral injection of a Technetium-99m nanocolloid. The sentinel nodes were defined as the nodes identified on lymphoscintigraphy, which were also radioactive intraoperatively using a gamma probe. In total, 18 groins from 11 patients underwent DSNB. Of these, 11 patients underwent bilateral DSNB and 4 had unilateral DSNB. The mean (range) age of patients at the time of presentation of their primary tumour was 63 (39-78) years. A mean of 1.2 nodes per groin was retrieved. One lymph node was positive in one patient, who subsequently underwent a bilateral inguinal lymph node dissection. Overall, the median (range) follow-up was 12.8 (2.7-31.3) months with no local or regional recurrences. Further cases and longer follow-up will define the accuracy of this technique in the Irish population.

Incidence of penile cancer worldwide: systematic review and meta-analysis.

ABSTRACTObjective.To determine the global incidence of penile cancer.Methods.A systematic review and meta-analysis of observational studies was performed, with no limits on their language of publication. Analyses were performed using Stata 13 statistical software. A random-effects model was used, according to the heterogeneity found in the studies. The main outcome was expressed in terms of age-standardized incidence.Results.A total of 23 studies were eligible, with 71 156 penile cancer patients in 86 countries. According to the review conducted, the estimated age-standardized incidence of penile cancer worldwide is 0.84 cases per 100 000 person-years (95% confidence interval: 0.79–0.89). Romania reported the highest incidence, 7.26 per 100 000 person-years, between 1983 and 1987; however, some countries in Latin America and Africa reported an incidence of between 2.0 and 5.7 per 100 000.Conclusions.Penile cancer is considered a rare malignancy due to its already-known, particularly low incidence rate. The estimated age-standardized incidence rate by the world standard population today is 0.84 cases per 100 000 person-years. There were no significant differences in the incidence rate of penile cancer with respect to the distribution by continent or the trend over time.

Programmed death ligand 1 expression and human papillomavirus status: penile cancer prognostic factors and new therapeutic opportunities

Penile cancer is a rare malignancy with limited treatment options beyond local resection and lymph node dissection. Risk factors for penile cancer development include phimosis, smoking, lack of circumcision, and human papillomavirus (HPV) infection. Based on cancer incidence and histologic subtyping, penile cancer is often stratified by HPV status. Cohort studies have found that HPV positive tumors have better prognosis. The success of HPV vaccination for the prevention of cervical cancer and genital warts has resulted in new recommendations for vaccination of men. However, these efforts would not be expected to improve outcomes in men with HPV negative tumors. New therapeutic strategies are needed to improve outcomes in men with advanced penile cancer. Programmed death ligand 1 (PD-L1) targeted treatments have been successful in other malignancies including melanoma and non-small cell lung cancer. Determining the frequency of PD-L1 positive tumor cells in penile cancer is needed to establish the potential benefit of using these targeted therapies in penile cancer patients. Evaluating the relationship between PD-L1 expression and HPV status may provide support for the proposed dual pathway to malignant transformation. Comparing PD-L1 status to HPV status should add another prognostic factor while expanding the therapeutic options for this malignancy.

Preoperative peripheral plasma fibrinogen level is an independent prognostic marker in penile cancer.

Background and aim: High levels of peripheral plasma fibrinogen have recently been revealed that related to poor clinical prognosis in various types of malignant tumors. The purpose of this research was to identify the prognostic significance of the preoperative peripheral serum fibrinogen level in patients with penile cell carcinoma.Methods: This retrospective research included 72 penile cancer patients with date about their serum fibrinogen value before surgery who undergone either partial or radical penectomy at The 2nd Hospital of Tianjin Medical University between January 2002 to January 2012. They had a mean follow-up of 30.8 months. To determine the factors that were significant in predicting a patients prognosis, univariate and multivariate analyses were performed according to the Cox proportional hazards regression model.Results: The 5-year cancer specific survival (CSS) rate was 62.4% of patients with preoperative fibrinogen levels below 340 mg/dl and 41.9% for those with higher levels (p = 0.001). Multivariate analysis revealed that the pathological T stage (p < 0.001), tumor grade (p = 0.036), postoperative chemotherapy (p = 0.041), nodal metastasis(p < 0.001), pathological type (p < 0.001) and fibrinogen (p = 0.023) were independent prognostic factors for survival. Patients with low fibrinogen level (<340mg/dl) had significantly longer CSS and the different survival rate were defined using the log-rank test.Conclusions: The high preoperative peripheral serum fibrinogen level was related to poor survival in penile cancer patients. Fibrinogen may serve as a powerful predictor of CSS in penile cancer patients.

Value and efficiency of sentinel lymph node diagnostics in patients with penile carcinoma with palpable inguinal lymph nodes as a new multimodal, minimally invasive approach

The international guidelines recommend sentinel lymph node biopsy (SLNB) for lymph node staging in penile cancer with non-palpable inguinal lymph nodes (LN) but it is not recommended with palpable inguinal LN. The aim of this study was to evaluate the reliability and morbidity of SLNB in combination with an ultrasound-guided resection of suspect inguinal LNs as a new multimodal, minimally invasive staging approach in these patients. We performed SLNB in 26 penile cancer patients with 42 palpable inguinal LNs. Prior to the combined staging procedures the patients underwent an ultrasound examination of the groins as well as planar lymphatic drainage scintigraphy and SPECT/CT scans. During the surgical procedure, the radioactive-labelled sentinel lymph nodes and, in addition, sonographically suspect LNs, were resected under ultrasound guidance. Follow-up screening was done by ultrasound examination of the groins according to the guidelines of the European Association of Urology. Nineteen groins of 42 preoperatively palpable inguinal findings were histologically tumor-positive. SLNB alone showed lymphogenic metastases in 14 groins. Sonography revealed five further metastatic groins, which would not have been detected during SLNB due to a tumor-related blockage of lymphatic drainage or a so-called re-routing of the tracer. During follow-up, none of the 28 groins with tumor-negative LN status showed any LN recurrence in this combined investigation technique. The median follow-up period was 46 (24 to 92) months. Morbidity of this procedure was low at 4.76% in relation to the number of groins resp. 7.69% in relation to the number of patients. The results show that this combined procedure is a reliable multimodal diagnostic approach for treatment of penile cancer patients with palpable inguinal LNs. It is associated with low morbidity rates. SLNB alone would lead to a significantly higher false-negative rate in these patients. The encouraging results of this work can extend the range of indications for nuclear medicine in the form of SLNB using radioactive tracers in this patient group.

10-Year experience regarding the reliability and morbidity of radio guided lymph node biopsy in penile cancer patients and the associated radiation exposure of medical staff in this procedure.

BackgroundThe guidelines of the European Association of Urologists (EAU), of the German Society of Nuclear Medicine (DGN), and the European Society for Medical Oncology (ESMO) recommend sentinel lymph node biopsy (SLNB) for lymph node staging in penile cancer with non-palpable inguinal lymph nodes as one diagnostic method. Despite this, the method is neither widely nor regularly applied in Germany – the same applies to many other countries, which may be due to insecurity in dealing with open radioactive tracers. This study aims to assess the reliability and morbidity of this method, as well as the associated radioactive burden for clinical staff.MethodsBetween 2006 and 2016, 34 patients with an invasive penile carcinoma and inconspicuous inguinal lymph node status underwent SLNB in 57 groins after application of a radiotracer (Tc-99 m nanocolloid). We collected the results prospectively. The reliability of the method was assessed by determining the false-negative rate. In addition, we evaluated complication rates and determined the radioactive burden for the clinical staff both pre- and intraoperatively.ResultsSLNB was performed in 34 patients with penile cancer with non-palpable inguinal lymph nodes in 57 groins. In two patients inguinal lymph node metastases were detected by means of SLNB. In one patient recurrent inguinal lymph node disease was found after negative SLNB in both groins. Thus, the false negative rate was 3.13 % per patient (1/32 patients) and 3.51 % per groin (2/57 groins). The morbidity rate was 2.94 % per patient (1/34 patients) and 1.75 % per groin (1/57 groins). Radiation exposure for the clinical staff during this procedure was low at a maximum of ca. four μSV per intervention.ConclusionsSLNB is a reliable method with low morbidity that is associated with a low radiation burden for clinical staff. Due to the enhanced methodological and logistic demands, this intervention should be performed in specialized centres and in an interdisciplinary approach.

Increased neutrophil-to-lymphocyte ratio is associated with disease-specific mortality in patients with penile cancer.

BackgroundThe neutrophil-to-lymphocyte ratio (NLR), a simple marker of the systemic inflammatory response, has been demonstrated to correlate with patient outcomes for various solid malignancies. We investigated the utility of the pretreatment NLR as a prognosticator in patients who presented with penile cancer.MethodsA total of 41 patients who underwent complete blood count with differential and subsequent radical penectomy from 1988 to 2014 were analyzed. We assessed the correlation between the NLR and the prognosis of penile cancer.ResultsThe median and mean (± SD) NLRs in 41 penile cancer patients were 3.42 and 5.03 ± 4.99, respectively. Based on the area under receiver operator characteristic curve, the cut-off value of NLR was determined to be 2.82. Patients with a high NLR (≥2.82) showed a significantly poorer cancer-specific survival (p = 0.023) than those with a low NLR.ConclusionsThe pretreatment NLR may function as a biomarker that precisely predicts the prognosis in patients with penile cancer.

P-05-014 Sarcopenia as a prognostic factor in penile cancer patients: assessment of body composition in patients with advanced penile cancer

P-05-014 Sarcopenia as a prognostic factor in penile cancer patients: assessment of body composition in patients with advanced penile cancer