Primary Tumor Related Prognostic Factors

Approximately 12-24% of patients with penile cancer and nonpalpable lymph nodes will have occult micrometastases.16 This has been confirmed by the finding of lymph node disease progression in 9-21% of men undergoing surveillance for clinically nonpalpable inguinal nodes (cN0).17,18 Among the individuals who progressed during surveillance, 50% did so within 6 months, 77% within 1 year, and 100% within 2 years following treatment of the primary tumor.17

Early bilateral inguinal lymph node dissections have been shown to significantly improve prognosis in patients with inguinal micrometastases. However, this surgery is associated with major complications in 24-87% of cases and can result in death in 3%.19 For this reason, inguinal lymphadenectomy might be considered as an over-treatment in 75-90% of cases, where micrometastases are not present. In order to minimize overtreatment and the resultant morbidity investigators have sought to study the pathological and molecular features of the primary tumor with a view to predicting regional lymph node involvement.

Histological subtype, local extension, grading, lymphatic and/or venous embolization, and perineural invasion within the primary tumor are the most important predictors of lymph node involvement in patients with penile cancer9,11. More controversial is the role of growth pattern, tumor thickness, and presence of HPV infection.

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