Presentation Authors: Mounsif Azizi*, Tampa, FL, David C. Boulware, Tampa , FL, Salim K. Cheriyan, Charles C. Peyton, Tampa, FL, Salvatore Lo Vullo, Luigi Mariani, Milan, Italy, Yao Zhu, Ding-Wei Ye, Shanghai, China, People's Republic of, Antonio Ornellas, Rio de Janeiro, Brazil, Nick Watkin, Michael Ager, London, United Kingdom, Oliver Hakenberg, Rostock, Germany, Daniele Raggi, Mario Catanzaro, Roberto Salvioni, Roberto Salvioni, Milan, Italy, Juan Chipollini, Scott M. Gilbert, Tampa , FL, Andrea Necchi, Milan, Italy, Philippe E. Spiess, Tampa, FL
Introduction: The main prognostic factors for survival among patients with penile squamous cell carcinoma (PSCC) remain the presence and the extent of lymph node metastasis (LNM). Known primary tumor (PT) factors predictive of pathologic node-positive (pN+) disease in clinical node-negative (cN0) patients include stage, vascular invasion and differentiation. We sought to determine further histopathological and patient-related predictors of LNM and survival in cN0 patients.
Methods: Using an international, multicenter, retrospective cohort of PSCC patients, we identified 743 patients who underwent regional lymph node dissection (LND) between 1980 and 2017. Outcomes were examined using Kaplan-Meier, adjusted logistic and Cox regression models.
Results: Of the 689 patients suitable for analyses, 328 (47.6%) were cN0. There were 141 (43%) cN0pN0 and 187 (57%) cN0pN+ patients. cN0pN+ patients had more vascular invasion (P=0.001) and more HPV-negative tumors (P < 0.001) compared to cN0pN0 patients. On adjusted logistic regression analysis, advanced age (P=0.03), bilateral LND (P=0.02) and time from PT surgery to LND surgery â‰¥3 months (OR=2.11; 95%CI 1.12-3.98, P=0.02) were independent predictors of pN+ disease in cN0 patients. On multivariable Cox regression analysis, node density (OR=6.82; 95%CI 2.32-12.1, P < 0.001) and pN2-3 stage (overall P < 0.01) were significantly associated with overall survival in cN0 patients.
Conclusions: Using the largest available retrospective cohort of PSCC patients undergoing regional LND, we identified several histopathological and patient-related prognosticators of pN+ disease and survival in cN0 patients. These factors can be used to enhance patient prognostication and clinical decision-making.