Pelvic Lymphadenopathy May Signal Worse Stage N3 Penile Cancer Survival

Author: By Shreeya Nanda, Senior medwireNews Reporter

medwireNews: Among men with stage N3 penile squamous cell cancer, patients with pelvic lymphadenopathy (PLN) have worse overall survival (OS) than those with inguinal extra-nodal extension (iENE), indicates a database analysis presented at the 37th Annual European Association of Urology Congress.

Researcher James Churchill, from The Christie NHS Foundation Trust in Manchester, UK, explained that the current TNM staging classification defines clinical N3 stage as the presence of PLN or fixed inguinal lymph node metastasis, and pathological N3 stage as metastasis in pelvic lymph nodes and/or ENE in any lymph node.

But the findings of the current study suggest that the TNM classification “should be refined by further stratifying the staging groups based on ENE and PLN status”, thereby “allowing more accurate prognostication for patients and guiding treatment decisions based on logical stage groupings”, he told the audience in Amsterdam, the Netherlands.

The researchers drew on The Christie NHS Foundation Trust database to identify 213 patients with penile squamous cell cancer and clinical suspicion of lymph node metastases at diagnosis between 2003 and 2021. About half (48%) were deceased at the time of analysis, which was conducted at a median follow-up of 64 months.

Kaplan–Meier analysis demonstrated significantly worse OS for the 43 patients with PLN and the 71 with iENE but no PLN relative to the 99 without either feature. The median OS times were 19.6 months, 25.4 months and not reached, respectively.

A direct comparison of the PLN and iENE groups showed that although median OS was numerically shorter in the former, the between-group difference was not statistically significant. Nevertheless, the data indicate “a sustained difference” between these cohorts, with the curves separating at around 12 months and “a long-term survival difference of about 15%”, highlighted the presenter.

The findings were similar in multivariate analysis adjusting for age and stage, such that men with PLN or iENE had a significantly increased risk of death relative to those without either feature, at hazard ratios (HRs) of 3.67 and 1.99, respectively.

And once again, the presence of PLN was only associated with a numerical, but not statistically significant, elevated risk versus the presence of iENE, with an HR of 1.62.

“In the coming months, we plan to analyse larger datasets through research networks and collaborative databases to provide sufficient statistical power to justify stratification of [the] N3 group based on ENE and PLN status”, concluded James Churchill.

Reference

Churchill J, Sachdeva A, Issa A, et al. Survival in N3 penile cancer: Does pelvic lymphadenopathy predict a worse prognosis than inguinal extra-nodal extension? 37th Annual EAU Congress; Amsterdam, the Netherlands: 1–4 July 202