Presentation Authors: Santosh Menon*, Akash Sali, Ganesh Bakshi, Gagan Prakash, Amit Joshi, Vedang Murthy, Sangeeta B Desai, Mumbai, India
Introduction: Penile cancer is an aggressive neoplasm and nodal metastasis is the most important prognostic factor which determines the outcome. Recently updated AJCC 8th edition has assigned corpora cavernosae involvement as pT3 stage in TNM classification.
Methods: Retrospective clinicopathologic analysis of consecutive penile squamous cell carcinoma patients who had undergone primary surgical treatment (penectomy specimens and circumcisions) with either upfront or follow-up unilateral/bilateral inguinal lymph node dissections from 2007-2012 was undertaken. Histopathology slides were reviewed and the anatomical level of invasion was defined as per AJCC 8th edition TNM pT stage [corpus spongiosum (CS) pT2 vs. corpus cavernosa (CS) pT3 involvement] and was correlated with nodal metastasis, disease free survival and overall survival. Multivariate analysis was performed using logistic regression models. Survival curves were calculated using the Kaplan-Meier method and Cox regression method. Comparisons between curves were done by Mantel-Cox (log-rank) test.
Results: A total of 162 cases of primary resections of penis with unilateral or bilateral groin node dissection (GND) were identified during the study period. Positive nodal basin was found in 120 patients on either upfront or follow- up nodal dissection. 7 patients with lamina (pT1 stage) and 113 patients with either CS or CC involvement had positive nodes. Corpus spongiosum was involved in 75 out of the 120 node positive cases in comparison to corpora cavernosa involved in 38 cases.There was no statistical difference in nodal metastasis between the tumors invading CS or CC (P=0.146).Follow-up was available in 145 patients (89.5%). Median follow- up was 21 months (1-96 months). Median disease free survival (DFS) was 8 months. Median overall survival (OS) for the whole group was 23 months. Disease free survival (DFS) correlated with lymph node metastasis (P < 0.001) but not with anatomical level of infiltration (P=0.133).Overall survival (OS) significantly correlated with presence of lymph nodal metastasis (P < 0.001) only.
Conclusions: Involvement of corpus cavernosa does not significantly correlate with nodal metastasis and disease outcome in penile cancer. The categorization of corpora cavernosa involvement in penile resection specimens as pT3 (AJCC 8th edition TNM staging) needs further evaluation.