Does pelvic lymph node dissection (PNLD) have a role in the treatment of penile cancer? Eur Urol Suppl 2014;13;e60
Yap T.L.1 , Shabbir M. 1 , Cullen I.1 , Lucky M. 1 , Handalage C.2 , Jameson C.1 , Nigam R.3 , Malone P. 4 , Akkers C.1 , Freeman A. 1 , Muneer A. 1 , Minhas S. 1 1 University
College Hospital, Dept. of Urology, London, United Kingdom, 2 University College London Hospitals NHS Foundation Trust, Dept.
of Urology, London, United Kingdom, 3 Royal Surrey County Hospital NHS Trust, Dept. of Urology, Guildford, United Kingdom, 4 Royal Berkshire Hospital NHS Foundation Trust, Dept. of Urology, Reading, United Kingdom INTRODUCTION & OBJECTIVES: The role of pelvic lymph node dissection for penile carcinoma is controversial. The EAU guidelines advocate pelvic lymph node dissection (PLND) in patients if 2 or more inguinal nodes/extra-capsular spread are involved, although this is based upon limited evidence. The aim of this study was to assess the detection rate and outcome of patients who underwent PLND as recommended by the EAU guidelines. MATERIAL & METHODS: A retrospective review of 37 patients undergoing PLND for penile cancer between 2000- 2012 for pN2 disease was performed. Age, tumour stage, grade, subtype, lymphovascular invasion (LVI), number of positive inguinal lymph nodes (ILN) and presence of extra nodal spread (ENS) were assessed and correlated with PLN status and outcome data. Fisher’s exact and unpaired t tests were used for analysis, with log-rank test to compare Kaplan Meier survival curves in PLND positive and negative groups. P values < 0.05 were taken as statistically significant. RESULTS:
37 patients underwent PLND for pN2 disease. The median age at PLND was 58 years (range 23 – 78). Nine patients (24%) had positive pelvic disease. At three years post PLND, two men with positive pelvic nodes had died (at 335 & 578 days) whilst 8 men (29%) with negative pelvic nodes died (median 385 days, range 233 to 633 days). There was no significant difference in survival curves between positive and negative PLND at 3 years (Hazard ratio 0.9, 95% CI 0.2 to 4.1, p = 0.89), although numbers were small. None of the variables
assessed, including number of inguinal nodes, were significantly associated with pelvic node involvement. Mortality was not significantly associated with PLN status or age, in this small cohort. CT scanning had high sensitivity (86%) but low specificity (38%) for determining pelvic node involvement in patients who proceeded to PLND. CONCLUSIONS: PLND has a low yield (24%) in patients undergoing surgery by the EAU guidelines. There were no significant associations between age, stage, grade, LVI, ENS or number of ILN and the presence of PND. CT staging, though sensitive for pelvic nodal disease, has a high false positive rate. Mortality was not significantly associated with PLN status. Men with positive or negative PLND have no significantly different 3-year survival rates which suggest that PLND may not be beneficial to all men. More work will need to be done in a larger dataset which will be challenging in this rare malignancy.