ABSTRACT
PURPOSE: We evaluated the role of primary tumor histopathological features for predicting regional metastasis and the prognosis in patients with penile squamous cell carcinoma. MATERIALS AND METHODS: From April 1996 to January 2007, 202 consecutive patients with penile carcinoma underwent surgical treatment at our institution. Of these patients 196 were studied to identify prognostic factors. All histological specimens were examined by the same pathologist. We considered certain histological parameters, including histological grade, invasion depth, lymphovascular embolization, perineural infiltration, infiltration of the corpus cavernosum or spongiosum, urethral infiltration and koilocytosis. RESULTS: Variables significantly associated with regional metastasis on univariate analysis were stage stratification (p = 0.0338), histological grade (p = 0.0112), invasion depth (0.0114), lymphovascular embolization (p <0.0001), perineural infiltration (p = 0.0092), corpora cavernosa infiltration (p = 0.0005) and koilocytosis (p = 0.0013). In the multivariable model lymphovascular embolization and absent koilocytosis were independent risk factors for lymphatic metastasis (p = 0.001 and 0.009, respectively). We also found a better survival rate in patients with koilocytosis and without lymphovascular embolization (p = 0.001 and 0.005, respectively). CONCLUSIONS: Lymphovascular embolization and absent koilocytosis were independent prognostic factors for the risk of lymphatic metastasis. Patients with koilocytosis and without lymphovascular embolization had better 5-year survival.
Subject(s)
Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/secondary , Neoplasm Invasiveness/pathology , Penile Neoplasms/mortality , Penile Neoplasms/pathology , Adult , Age Factors , Aged , Aged, 80 and over , Analysis of Variance , Biomarkers, Tumor/blood , Biopsy, Needle , Brazil , Carcinoma, Squamous Cell/therapy , Chi-Square Distribution , Cohort Studies , Combined Modality Therapy , Humans , Immunohistochemistry , Lymph Node Excision/methods , Lymphatic Metastasis , Male , Middle Aged , Multivariate Analysis , Neoplasm Staging , Penile Neoplasms/therapy , Probability , Prognosis , Registries , Retrospective Studies , Risk Assessment , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVES: We reviewed our long-term experience with surgical treatment of patients with penile carcinoma. METHODS: From 1960 to 2006, 688 patients with penile carcinoma underwent surgical treatment at our Institute. Several forms of surgical treatment were compared and follow-up data analyzed. RESULTS: Stage stratification demonstrated a better survival rate for patients with stages T1N0 and T1N1,T2N0-1. Patients with well differentiated carcinoma had a higher survival rate than those with moderately and poorly differentiated carcinoma (P < 0.0001 and P = 0.006). Risk stratification showed a better survival rate for patients in the low-risk group (T1G1,T1G2) (P = 0.013 and P < 0.00001). Patients in the intermediate group (T2G1,T2G2,T3G1,T3G2) presented a higher survival rate than patients in the high-risk group (T1-3G3,T4G1-3) (P < 0.00001). Patients who underwent immediate lymphadenectomy had a better survival rate than those who underwent delayed lymphadenectomy (P = 0.002). CONCLUSIONS: Stage and tumor grade affected the prognosis of the disease. The presence and the extent of metastasis to the inguinal region were the most important prognostic factors for survival in our patients. Immediate lymphadenectomy is indicated in all patients. Since recurrences were noted within 8, 10, and 25 years after primary treatment, a frequent and lasting follow-up is essential for all patients.