Patterns of Recurrence following Inguinal Lymph Node Dissection for Penile Cancer: Optimizing Surveillance Strategies

No AccessJournal of UrologyAdult Urology1 Oct 2021Patterns of Recurrence following Inguinal Lymph Node Dissection for Penile Cancer: Optimizing Surveillance StrategiesThis article is commented on by the following:Editorial Comment Nicholas H. Chakiryan, Aaron Dahmen, Marco Bandini, Filippo Pederzoli, Laura Marandino, Maarten Albersen, Eduard Roussel, Yao Zhu, Ding-Wei Ye, Antonio A. Ornellas, Mario Catanzaro, Oliver W. Hakenberg, Axel Heidenreich, Friederike Haidl, Nick Watkin, Michael Ager, Jad Chahoud, Alberto Briganti, Roberto Salvioni, Francesco Montorsi, Andrea Necchi, and Philippe E. Spiess Nicholas H. ChakiryanNicholas H. Chakiryan H. Lee Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, Florida , Aaron DahmenAaron Dahmen †Correspondence: University of South Florida, Department of Urology, 2 Tampa General Circle, Tampa, Florida 33606.telephone: 615-684-5354; E-mail Address: [email protected] University of South Florida, Department of Urology, Tampa, Florida , Marco BandiniMarco Bandini Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy , Filippo PederzoliFilippo Pederzoli Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy , Laura MarandinoLaura Marandino Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy , Maarten AlbersenMaarten Albersen University Hospitals Leuven, Leuven, Belgium , Eduard RousselEduard Roussel University Hospitals Leuven, Leuven, Belgium , Yao ZhuYao Zhu Fudan University Shanghai Cancer Center, Shanghai, China , Ding-Wei YeDing-Wei Ye Fudan University Shanghai Cancer Center, Shanghai, China , Antonio A. OrnellasAntonio A. Ornellas Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil , Mario CatanzaroMario Catanzaro Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy , Oliver W. HakenbergOliver W. Hakenberg University Hospital Rostock, Rostock, Germany , Axel HeidenreichAxel Heidenreich Universitätsklinikum Köln, Köln, Germany , Friederike HaidlFriederike Haidl Universitätsklinikum Köln, Köln, Germany , Nick WatkinNick Watkin Universitätsklinikum Köln, Köln, Germany , Michael AgerMichael Ager Universitätsklinikum Köln, Köln, Germany , Jad ChahoudJad Chahoud H. Lee Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, Florida , Alberto BrigantiAlberto Briganti Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy , Roberto SalvioniRoberto Salvioni Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy , Francesco MontorsiFrancesco Montorsi Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy , Andrea NecchiAndrea Necchi Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy , and Philippe E. SpiessPhilippe E. Spiess H. Lee Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, Florida View All Author Informationhttps://doi.org/10.1097/JU.0000000000001790AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Our primary objective is to detail the incidence, site, and timing of penile squamous cell carcinoma (pSCC) recurrence after inguinal lymph node dissection (ILND). Materials and Methods: We performed a retrospective analysis of 551 patients who underwent ILND for pSCC from 2000 to 2017. The primary outcome was pSCC recurrence after ILND. Recurrences were identified and stratified by site. Timing of recurrence was determined. Multivariable logistic regression analysis determined associations with recurrence. Multivariable Cox regression analysis determined associations with overall survival (OS). Sub-group analysis of the distant recurrences analyzed timing and OS by site of distant recurrence. Results: After ILND pSCC recurred in 176 (31.9%) patients. Median time to recurrence was 10 months for distant recurrences, 12 for inguinal, 10.5 for pelvic, and 44.5 for local. Greater than 95% of distant, inguinal, and pelvic recurrences occurred within 48 months of ILND, versus 127 months for local recurrences. Post-ILND recurrence was associated with pN2 (OR 1.99, 95% CI 1.0–4.1), and pN3 (OR 7.2, 95% CI 4.0–13.7). Patients who had local recurrence had similar OS to those without (HR 1.5, 95% CI 0.6–3.8), and worse OS was identified in patients with inguinal (HR 4.5, 95% CI 2.8–7.1), pelvic (HR 2.6, 95% CI 1.5–4.5), or distant (HR 4.0, 95% CI 2.7–5.8) recurrences. Patients with lung recurrences had worse OS than other sites (HR 2.2, 95% CI 1.1–4.3). Conclusions: Of the patients 31.9% had post-ILND recurrence associated with high pN staging. Greater than 95% of distant, inguinal, and pelvic recurrences occurred within 48 months, suggesting surveillance beyond this is low yield. Local recurrences occurred over a longer timeline, emphasizing necessity of long-term surveillance of the primary site. References 1. : Profile of patients with penile cancer in the region with the highest worldwide incidence. Sci Rep 2020; 10: 2965. Google Scholar 2. : Epidemiologic study on penile cancer in Brazil. Int Braz J Urol 2008; 34: 587. Google Scholar 3. : EAU guidelines on penile cancer: 2014 update. Eur Urol 2015; 67: 142. Google Scholar 4. National Comprehensive Cancer Network: Penile Cancer (Version 2.2021). Available at http://www.nccn.org/professionals/physician_gls/pdf/penile.pdf. Google Scholar 5. : Prognostic factors in node-positive carcinoma of the penis. J Surg Oncol 2006; 93: 133. Google Scholar 6. : Oncologic outcomes of penile cancer treatment at a UK supraregional center. Urology 2015; 85: 1097. Google Scholar 7. : Challenges and opportunities in measuring cancer recurrence in the United States. J Natl Cancer Inst 2015; 107: djv134. Google Scholar 8. : A risk calculator predicting recurrence in lymph node metastatic penile cancer. BJU Int 2020; 126: 577. Google Scholar 9. : Nomogram-based prediction of overall survival after regional lymph node dissection and the role of perioperative chemotherapy in penile squamous cell carcinoma: a retrospective multicenter study. Urol Oncol Semin Orig Investig 2019; 37: 531.e7. Google Scholar 10. : The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17: 1471. Google Scholar 11. : Updates in the eighth edition of the tumor-node-metastasis staging classification for urologic cancers. Eur Urol 2018; 73: 560. Google Scholar 12. : Predictors of cancer-specific mortality after disease recurrence in patients with squamous cell carcinoma of the penis. Eur Urol 2014; 66: 811. Google Scholar 13. : Recurrence patterns of squamous cell carcinoma of the penis: recommendations for follow-up based on a two-centre analysis of 700 patients. Eur Urol 2008; 54: 161. Google Scholar 14. : A study into the association between local recurrence rates and surgical resection margins in organ-sparing surgery for penile squamous cell cancer. BJU Int 2018; 122: 576. Google Scholar 15. : Conservative surgery for squamous cell carcinoma of the penis: resection margins and long-term oncological control. J Urol 2012; 188: 803. Link, Google Scholar 16. : What surgical resection margins are required to achieve oncological control in men with primary penile cancer?BJU Int 2005; 96: 1040. Google Scholar Editor's Note: This article is the third of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1074 and 1075. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2021) This Month in Adult UrologyJournal of Urology, VOL. 206, NO. 4, (799-800), Online publication date: 1-Oct-2021.Related articlesJournal of UrologyAug 11, 2021, 12:00:00 AMEditorial Comment Volume 206Issue 4October 2021Page: 960-969Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordspenile neoplasmsneoplasm metastasisrecurrenceMetricsAuthor Information Nicholas H. Chakiryan H. Lee Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, Florida Equal study contribution. More articles by this author Aaron Dahmen University of South Florida, Department of Urology, Tampa, Florida †Correspondence: University of South Florida, Department of Urology, 2 Tampa General Circle, Tampa, Florida 33606.telephone: 615-684-5354; E-mail Address: [email protected] Equal study contribution. More articles by this author Marco Bandini Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy More articles by this author Filippo Pederzoli Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy More articles by this author Laura Marandino Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Maarten Albersen University Hospitals Leuven, Leuven, Belgium More articles by this author Eduard Roussel University Hospitals Leuven, Leuven, Belgium More articles by this author Yao Zhu Fudan University Shanghai Cancer Center, Shanghai, China More articles by this author Ding-Wei Ye Fudan University Shanghai Cancer Center, Shanghai, China More articles by this author Antonio A. Ornellas Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil More articles by this author Mario Catanzaro Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Oliver W. Hakenberg University Hospital Rostock, Rostock, Germany More articles by this author Axel Heidenreich Universitätsklinikum Köln, Köln, Germany More articles by this author Friederike Haidl Universitätsklinikum Köln, Köln, Germany More articles by this author Nick Watkin Universitätsklinikum Köln, Köln, Germany More articles by this author Michael Ager Universitätsklinikum Köln, Köln, Germany More articles by this author Jad Chahoud H. Lee Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, Florida More articles by this author Alberto Briganti Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy More articles by this author Roberto Salvioni Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Francesco Montorsi Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy More articles by this author Andrea Necchi Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy More articles by this author Philippe E. Spiess H. Lee Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, Florida More articles by this author Expand All Editor's Note: This article is the third of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1074 and 1075. Advertisement Loading ...