Primary Tumor Pathological Extension pT

In individuals with nonmetastatic disease, the prognostic importance of the pathological stage of the primary tumor is related to its association with the presence of occult metastases in nonpalpable inguinal lymph nodes. There is an unequivocally direct correlation between the local extension of the primary tumor and the risk of involvement of regional nodes. The presence of pathological lymph node involvement is 0-58% in pT1 tumors, 43-82% in pT2, and 50-100 in pT3 tumors.8

Recently, Lont et al. reported a 5-year survival of 95% in patients with pT1 penile cancer, which is significantly higher than the 74% observed for patients with pT2-3 disease (p = 0.003). In this particular investigation evaluating 176 patients, pathological stage of the primary tumor turned out to be an independent prognostic factor for survival (HR 4.0-95% CI 1.1-14.0), together with vascular embolization (HR 4.5-95% CI 1.4-14.6) and regional lymph node metastases (HR 7.0-95% CI 2.8-17.6).24 However, conflicting data had previously been reported. Bezerra et al. analyzed data from 82 patients, reporting 5-year cancer-specific survival rates of 80% in pT1, 62% in pT2, 64% in pT3, without any statistically significant difference amongst stages. 1 0 Similarly, in 2002 Lopes et al. reported 5-year cancer-specific survival rates of 57% in pT1, 52% in pT2, and 49% in pT3 neoplasms.20

In 2008, Leijte et al. demonstrated that the current TNM classification required updating in order to better stratify the patients according to the local extension of

the primary tumor. They demonstrated that patients classified as pT2 did not have a different cancer-specific survival in comparison with those classified as pT3. For this reason, they proposed to reclassify patients with penile cancer distinguishing the cases with invasion of the corpus spongiosum (new pT2) from those with invasion of the corpora cavernosa (new pT3). Also, a new pT4 category was suggested, which would include tumors invading adjacent structures (including prostate). This proposed update of the pT stage allowed the authors to stratify patients with penile cancer into subgroups with significantly different prognoses.15

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