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Lenart S, Koperek O, Scharrer A, Comperat E. "Bone in the penis" or fasciitis ossificans of the penis - a first time description of a pseudo-tumor at an extraordinary site. BMC Urol 2024; 24:83. [PMID: 38594664 PMCID: PMC11005136 DOI: 10.1186/s12894-024-01475-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Fasciitis ossificans is a rare subtype of nodular fasciitis, a benign soft tissue tumor with reactive characteristics. Due to its rapid growth, it is often misdiagnosed as a malignant tumor. While fasciitis ossificans commonly originates from the subcutaneous tissue and can appear throughout the body, it may also arise from extraordinary sites. CASE PRESENTATION We report the first-ever documented case of fasciitis ossificans arising from the penis in a male patient who presented with a tumor on the glans penis. The tumor was surgically resected due to suspicion of penile cancer. Initial histopathological analysis led to a misdiagnosis of squamous cell carcinoma. However, pathological consultation ultimately confirmed the diagnosis of fasciitis ossificans of the penis originating from the glans penis by demonstrating ossification. CONCLUSION This case underscores the importance of considering fasciitis ossificans in the differential diagnosis of soft tissue tumors, even in unusual locations such as penile soft tissue.
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Affiliation(s)
- Sebastian Lenart
- Department of Urology and Andrology, St. John of God Hospital, Vienna, Austria.
- Department of Urology, Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Oskar Koperek
- Laboratories for pathology Kaserer, Koperek and Beer, Vienna, Austria
| | - Anke Scharrer
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - Eva Comperat
- Department of Pathology, Medical University Vienna, Vienna, Austria
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Yuan P, Xie Y, Xu R, Li Y, Yao K, Liu J, Yan B, Jiang S, Lu Q, Chen Q, Zang H, Xiong W, Tang Y, Hu S, Wang L. Efficacy of indocyanine green fluorescence-guided inguinal lymph node dissection for penile cancer: a randomised trial. BJU Int 2024; 133:442-450. [PMID: 37983593 DOI: 10.1111/bju.16231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To investigate the safety and efficacy of indocyanine green (ICG) fluorescence-guided inguinal lymph node dissection (ILND) in patients with penile cancer. PATIENTS AND METHODS A prospective, single-blind, randomised controlled clinical trial (ChiCTR2100044584) was performed among patients with penile caner who underwent bilateral modified ILND at four centres in China between 1 April 2021 and 30 June 2022. Patients aged 18-80 years and diagnosed with squamous cell carcinomas were included. Each enrolled patient was randomly assigned to either ICG fluorescence-guided ILND by a laparoscopic or robot-assisted approach in one groin, with non-ICG fluorescence-guided ILND in the other groin acting as a control. The primary outcome was the number of retrieved ILNs. Secondary outcomes included complications according to the Clavien-Dindo classification and the ILN non-compliance (inadequate removal of ILNs) rate. RESULTS A total of 45 patients were included in the intention-to-treat (ITT) analysis, and the 42 who completed the entire study were included in the per protocol (PP) analysis. There were no ICG-related complications in any of the patients. The results of the ITT and PP analyses indicated that the total number of unilateral ILNs retrieved was higher on the ICG side than on the non-ICG side (mean 13 vs 9 ILNs, difference 4 ILNs [95% CI 2.7-4.4], P = 0.007), and the number of unilateral deep and superficial ILNs was higher on the ICG side. Furthermore, the LN non-compliance rate was lower on the ICG side than on the non-ICG side. Additionally, there was no significant difference in local complications in the groins between the two sides (P > 0.05). CONCLUSION An ICG fluorescence-guided ILND was safe for patients with penile cancer. This procedure can improve the number of ILNs retrieved and reduce the LN non-compliance rate without increased complications. ICG fluorescence-guided ILND is beneficial and recommended for selected patients with penile cancer.
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Affiliation(s)
- Peng Yuan
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yu Xie
- Department of Urology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuanwei Li
- Department of Urology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Kun Yao
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jianye Liu
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Bin Yan
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shusuan Jiang
- Department of Urology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Qiang Lu
- Department of Urology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Qian Chen
- Department of Pathology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Hongjing Zang
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Xiong
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Long Wang
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
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Yan X, Liu C, Cui L, Yan P, Fu X, Chen W, Yang X. Near-infrared fluorescence-assisted superficial inguinal lymph-node excision for low-risk penile cancer. World J Urol 2024; 42:206. [PMID: 38561548 DOI: 10.1007/s00345-024-04877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/17/2023] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Identification of superficial inguinal lymph nodes during low-risk penile cancer surgery using near-infrared (NIR) fluorescence to improve the accuracy of lymph-node dissection and reduce the incidence of missed micrometastases and complications. METHODS Thirty-two cases were selected, which were under the criteria of < T1, and no lymph-node metastasis was found with magnetic resonance imaging (MRI) detection. Two groups were randomly divided based on the fluorescence technique, the indocyanine green (ICG) group and the non-ICG group. In the ICG group, the ICG preparation was subcutaneously injected into the edge of the penile tumor 10 min before surgery, and the near-infrared fluorescence imager was used for observation. After the lymph nodes were visualized, the superficial inguinal lymph nodes were removed first, and then, the penis surgery was performed. The non-ICG group underwent superficial inguinal lymph-node dissection and penile surgery. RESULTS Among the 16 patients in the ICG group, we obtained 11 lymph-node specimens using grayscale values of images (4.13 ± 0.72 vs. 3.00 ± 0.82 P = 0.003) along with shorter postoperative healing time (7.31 ± 1.08 vs. 8.88 ± 2.43 P = 0.025), and less lymphatic leakage (0 vs. 5 P = 0.04) than the 16 patients in the non-ICG group. Out of 11, 3 lymph nodes that are excised were further grouped into fluorescent and non-fluorescent regions (G1/G2) and found to be metastasized. CONCLUSION Near-infrared fluorescence-assisted superficial inguinal lymph-node dissection in penile carcinoma is accurate and effective, and could reduce surgical complications.
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Affiliation(s)
- Xiaoting Yan
- First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, People's Republic of China
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 030001, People's Republic of China
| | - Chao Liu
- Academy of Medical Sciences, Shanxi Medical University, Taiyuan, 030001, People's Republic of China
| | - Lijuan Cui
- Academy of Medical Sciences, Shanxi Medical University, Taiyuan, 030001, People's Republic of China
| | - Pengyu Yan
- First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, People's Republic of China
| | - Xiurong Fu
- First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, People's Republic of China
| | - Weiyi Chen
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, People's Republic of China.
| | - Xiaofeng Yang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, People's Republic of China.
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 030001, People's Republic of China.
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Ozambela M, McCormick BZ, Rudzinski JK, Pieretti AC, González GMN, Meissner MA, Papadopoulos JN, Adibi M, Matin SF, Dahmen AS, Spiess PE, Pettaway CA. Robotic or open superficial inguinal lymph node dissection as staging procedures for clinically node negative high risk penile cancer. Urol Oncol 2024; 42:120.e1-120.e9. [PMID: 38388244 DOI: 10.1016/j.urolonc.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To evaluate perioperative and oncologic outcomes of a cohort of clinically node negative high-risk penile cancer patients undergoing robotic assisted inguinal lymph node dissection (RAIL) compared to patients undergoing open superficial inguinal lymph node dissection (OSILND). PATIENTS AND METHODS We retrospectively reviewed the clinical characteristics and outcomes of clinically node negative high-risk penile cancer patients undergoing RAIL at MDACC from 2013-2019. We sought to compare this to a contemporary open cohort of clinically node negative patients treated from 1999 to 2019 at MDACC and Moffit Cancer Center (MCC) with an OSILND. Descriptive statistics were used to characterize the study cohorts. Comparison analysis between operative variables was performed using Fisher's exact test and Wilcoxon's rank-sum test. The Kaplan-Meier method was used to estimate survival endpoints. RESULTS There were 24 patients in the RAIL cohort, and 35 in the OSILND cohort. Among the surgical variables, operative time (348.5 minutes vs. 239.0 minutes, P < 0.01) and the duration of operative drain (37 vs. 22 days P = 0.017) were both significantly longer in the RAIL cohort. Complication incidences were similar for both cohorts (34.3% for OSILND vs. 33.3% for RAIL), with wound complications making up 33% of all complications for RAIL and 31% of complications for OSILND. No inguinal recurrences were noted in either cohort. The median follow-up was 40 months for RAIL and 33 months for OSILND. CONCLUSIONS We observed similar complication rates and surgical variable outcomes in our analysis apart from operative time and operative drain duration. Oncological outcomes were similar between the two cohorts. RAIL was a reliable staging and potentially therapeutic procedure among clinically node negative patients with penile squamous cell carcinoma with comparable outcomes to an OSILND cohort.
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Affiliation(s)
- Manuel Ozambela
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Barrett Z McCormick
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jan K Rudzinski
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Matthew A Meissner
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John N Papadopoulos
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mehrad Adibi
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Surena F Matin
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aaron S Dahmen
- Department of Urology at University of Chicago, Chicago, IL
| | - Philippe E Spiess
- Department of Genitourinary Oncology at Moffit Cancer Center, Tampa, FL
| | - Curtis A Pettaway
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX.
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Warli SM, Ginting JT, Sihombing B, Siregar GP, Prapiska FF. Comparison of Early Inguinal Lymph Node Dissection and Neoadjuvant Chemotherapy in Penile Cancer Patient with Bulky Nodal Metastasis: A Cohort Study. Urol J 2024; 21:47-51. [PMID: 37013859 DOI: 10.22037/uj.v20i.7448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/19/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Penile cancer is a rare malignancy, where extranodal extension in inguinal or pelvic lymph nodes is associated with decreased 5-year cancer-survival rate in this study, we try to assess survival and quality of life in a penile cancer patient with bulky lymph node. METHODS We retrospectively reviewed data from penile cancer patients with bulky lymph nodes who underwent treatment between July 2016 and July 2021 at tertiary referral hospital care. The inclusion criteria (age >18 yr, histologically proven penile cancer, and completion of last treatment 6 months prior to this study) yielded a cohort of 20 eligible penile cancer patients with bulky lymph nodes (> 4 cm/bilateral mobile/unilateral fixed). Only patients who had completed therapy at least 6 months prior to the study were included. After obtaining consent, they were asked to complete the EORTC QLQ-C30 questionnaire to evaluate the patient's quality of life. RESULTS Out of 20 patients, 5 patients underwent direct ILND and 15 patients underwent chemotherapy. Median follow-up after primary diagnosis was 114+32 months in patients with early ILND and 52+11 months in patients who underwent delayed lymph node dissection. Out of 5 patients who underwent early ILND, all of them survived during follow-up, and achieved cancer-free status without residual tumor and with excellent functional outcomes (Karnofsky 90). There was no significant difference in social function (p-value = 0.551), physical function (p-value = 0.272), role function (p-value = 0.546), emotional function (p-value = 0.551), cognitive function (p-value = 0.453), and global health status (p-value = 0.893) between patient which treated with early ILND and Neoadjuvant Chemotherapy. However, patients who underwent early ILND showed a relatively better clinical outcome. CONCLUSION Early ILND followed by adjuvant chemotherapy for penile cancer with palpable lymph nodes is more favourable than neoadjuvant TIP chemotherapy.
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Affiliation(s)
- Syah Mirsya Warli
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital.
| | - Jeremy Thompson Ginting
- Department of Urology, Faculty of Medicine, Universitas Indonesia - Haji Adam Malik General Hospital, Indonesia .
| | - Bungaran Sihombing
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Indonesia
| | - Ginanda Putra Siregar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Indonesia
| | - Fauriski Febrian Prapiska
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Indonesia
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Alvarado-Cabrero I, Fernández-Nestosa MJ, Valencia-Cedillo R, Urizar C, Cañete-Portillo S, Sánchez DF, Cubilla AL. Gradual and synergistic correlation of tumor thickness and histological grade in penile invasive carcinomas. Hum Pathol 2024; 144:77-82. [PMID: 38278449 DOI: 10.1016/j.humpath.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 01/28/2024]
Abstract
Histological grade and depth of invasion are among the best outcome pathological predictors in penile cancer. The TNM system is based on a combination of both for some stages. It is assumed that high-grade and deep tumors carry the worst prognosis, and the opposite occurs with superficial and low-grade neoplasms. However, there is no systematic evaluation of the phenomenon. We studied 147 patients from the Hospital de Oncologia - Instituto Mexicano del Seguro Social (period 2000 to 2013). They were treated by total or partial penectomies. Lymph node involvement was evaluated by bilateral inguinal node dissection (126 cases) or ultrasonography (21 cases). Tumor thickness was measured in mm from tumor surface to deepest invasion point, using a cut-point for superficial (≤10 mm) vs deep (>10 mm) tumors. Histological grade was from 1 to 3 according to WHO and AFIP criteria and considering G1 and G2 as low-grade and G3 as high-grade. Average age was 62 (26-98) years old. Tumor thickness mean was 15 mm (2-30 mm). G1, G2 and G3 tumors corresponded to 19 (13 %), 48 (33 %), and 80 (54 %) cases, respectively. Follow-up ranged from 10 to 82 months (median: 57 months). Fifty-three (36 %) patients died of disease. There was an overall correlation of tumor thickness and grade in most of the cases. Low-grade tumors were encountered in 92 % (12/13 cases) of superficial tumors. Deep tumors showed high-grade in 75 % of cases (73/97 cases). Superficial tumors with low histological grade had negative inguinal nodes and no mortality whereas deep tumors showing high histological grade were associated with high metastatic risk to lymph nodes (62/73 cases) and mortality (52/73 cases). Out of 24 deep tumors with low histological grade, seven had nodal spread (29 %) but only one died of disease. No outcome difference was found in HPV associated vs HPV independent tumors. Tumor thickness and grade are important synergistic and predictive pathological factors in relation to prognosis.
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Affiliation(s)
- Isabel Alvarado-Cabrero
- Hospital de Oncología, Centro Médico Nacional Siglo XXI, 06600, Alc. Cuauhtémoc, Ciudad de México, Mexico
| | | | - Raquel Valencia-Cedillo
- Hospital de Oncología, Centro Médico Nacional Siglo XXI, 06600, Alc. Cuauhtémoc, Ciudad de México, Mexico
| | - César Urizar
- Instituto de Patología e Investigación, Asunción, 1228, Paraguay
| | - Sofía Cañete-Portillo
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Diego F Sánchez
- Instituto de Patología e Investigación, Asunción, 1228, Paraguay; Translational Oncogenomics Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester Cancer Research Centre, Manchester, M20 4GJ, UK
| | - Antonio L Cubilla
- Universidad Nacional de Asunción, San Lorenzo, 2111, Paraguay; Instituto de Patología e Investigación, Asunción, 1228, Paraguay.
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Pinkheaw N, Sathitruangsak C, Tanthanuch M, Bejrananda T. Real world data of recurrent and survival rates of penile cancer patients in Songklanagarind hospital: Tumor stage as a predictor for disease-free survival. Int J Urol 2024; 31:144-153. [PMID: 37846171 DOI: 10.1111/iju.15326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE This study investigated disease-free survival and oncological outcomes in penile cancer patients treated surgically at a high-volume center and identified the prognostic factors for disease-free survival. METHODS A retrospective analysis was conducted on primary penile cancer patients diagnosed and treated at Songklanagarind Hospital, Thailand, between January 2001 and December 2021. Disease-free survival (DFS) was assessed using Kaplan-Meier survival curves, and Cox proportional hazard models were used for multivariate analysis. RESULTS The study included 188 patients with primary penile cancer. The majority (98.4%) were uncircumcised. Tumor staging revealed 40.6% with T1 tumors, 72.9% with well-differentiated tumors, and 23.5% diagnosed at stage IIIA. The recurrence rate was 19.1%, with a mean time to recurrence of 25.9 months. Disease-free survival rates at 1, 3, and 5 years were 81.1%, 70.9%, and 70.9%, respectively. Median overall survival was 16.43 months, with survival rates at 1, 3, and 5 years at 67.7%, 42.7%, and 35.4%, respectively. Cox proportional hazard models showed significant associations between disease-free survival and a higher T stage, a high level of CRP (>15 mg/L), delayed onset of symptoms, primary lesion location, groin node metastasis, lymphovascular invasion, and pelvic lymph node metastases. However, multivariate analysis revealed that a higher primary tumor stage (T) was the only independent prognostic factor for disease-free survival. CONCLUSION This study presents one of the largest cohorts investigating disease-free survival outcomes in penile cancer treatment at a single institution over a prolonged period. A higher pathologic T stage is a significant prognostic factor for disease-free survival. Further large-scale prospective studies are needed for validation.
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Affiliation(s)
- Natthakan Pinkheaw
- Division of Urology, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chirawadee Sathitruangsak
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand, Prince of Songkla University, Songkhla, Hat Yai, Thailand
| | - Monthira Tanthanuch
- Division of Urology, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Tanan Bejrananda
- Division of Urology, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Colecchia M, Pini GM, Pruneri G, Nicolai N, Servillo S. Soft tissue tumours of the penis. The 30-year Istituto Nazionale Tumori di Milano experience. Pathologica 2024; 116:46-54. [PMID: 38482674 PMCID: PMC10938274 DOI: 10.32074/1591-951x-953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 03/17/2024] Open
Abstract
Objective Small series and individual cases of penile soft tissue tumours are reported in the literature: these are rare tumours that represent less than 5% of all penile tumours. Methods Penile soft tissue tumours were collected from the archive of the Department of Pathology at the Istituto Nazionale dei Tumori of Milan between January 1990 and October 2021. All available medical records were retrieved and reviewed to obtain clinical information. Results Our series refers to the 30-year experience of highlighting the heterogeneity in the presentation and microscopic features of these rare sarcomas. 18 penile soft tissue tumours are described, 4 benign and 14 malignant. The mean age at diagnosis was 58.2 years (range 24-96 years) and 53.6 years among malignancies (range 24-89). The most frequent histotype was Kaposi's sarcoma (nr = 4) and very unusual histotypes were observed, namely low-grade fibromyxoid sarcoma, synovial sarcoma, proximal type epithelioid sarcoma and the first reported case of dedifferentiated liposarcoma of the penis. Conclusions Among sarcomas of the genitourinary tract, tumours of the soft tissues of the penis are the rarest. Penile sarcomas can present at a young age. Kaposi's sarcoma in HIV-negative patients has a favorable outcome, while deep sarcomas have an aggressive behavior and poor prognosis.
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Affiliation(s)
- Maurizio Colecchia
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Maria Pini
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, Foundation IRCCS National Cancer Institute, Milan, Italy
- Department of Oncology and Hematoncology, University of Milan, Milan, Italy
| | - Nicola Nicolai
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sascia Servillo
- Pathology Unit, Azienda Ospedaliera di Bergamo, Bergamo, Italy
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Musi G, de Cobelli O, Molinari F, Mistretta FA, Piccinelli ML, Nardini S, Tozzi M, Bianchi R, Fontana M, Di Trapani E, Cioffi A, Brescia A, Cordima G, Bottero D, Ferro M, Matei DV, Fusco N, Luzzago S. Oncological Outcomes of Thulium-Yttrium-Aluminum-Garnet (Tm:YAG) Laser Ablation for Penile Cancer. Urology 2024; 184:149-156. [PMID: 38092326 DOI: 10.1016/j.urology.2023.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To report oncological outcomes after thulium-yttrium-aluminum-garnet (Tm:YAG) laser ablation for penile cancer patients. MATERIALS AND METHODS We retrospectively analyzed 71 patients with ≤cT1 penile cancer (2013-2022). All patients underwent Tm:YAG ablation with a RevoLix 200W continuous-wave laser. First, Kaplan-Meier plots and multivariable Cox regression models tested local tumor recurrence rates. Second, Kaplan-Meier plots tested progression-free survival (≥T3 and/or N1-3 and/or M1). RESULTS Median (interquartile range) follow-up time was 38 (22-58) months. Overall, 33 (50.5%) patients experienced local tumor recurrence. Specifically, 19 (29%) vs 9 (14%) vs 5 (7.5%) patients had 1 vs 2 vs 3 recurrences over time. In multivariable Cox regression models, a trend for higher recurrence rates was observed for G3 tumors (hazard ratio:6.1; P = .05), relative to G1. During follow-up, 12 (18.5%) vs 4 (6.0%) vs 2 (3.0%) men were retreated with 1 vs 2 vs 3 Tm:YAG laser ablations. Moreover, 11 (17.0%) and 3 (4.5%) patients underwent glansectomy and partial/total penile amputation. Last, 5 (7.5%) patients experienced disease progression. Specifically, TNM stage at the time of disease progression was: (1) pT3N0; (2) pT2N2; (3) pTxN3; (4) pT1N1 and (5) pT3N3, respectively. CONCLUSION Tm:YAG laser ablation provides similar oncological results as those observed by other penile-sparing surgery procedures. In consequence, Tm:YAG laser ablation should be considered a valid alternative for treating selected penile cancer patients.
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Affiliation(s)
- Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
| | - Filippo Molinari
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesco A Mistretta
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
| | | | - Sara Nardini
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Tozzi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Bianchi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Fontana
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Cioffi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Brescia
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Giovanni Cordima
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Danilo Bottero
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Deliu-Victor Matei
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicola Fusco
- Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy; Division of Pathology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy.
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Holland LC, Gerald TS, Brooks B, Margulis V. A Targeted, Personalized Management Strategy in Advanced Penile Squamous Cell Carcinoma. Urology 2024; 184:71-74. [PMID: 38056508 DOI: 10.1016/j.urology.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/19/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
Penile squamous cell carcinoma (PSCC) is a rare malignancy with poor outcomes in advanced stages, with dismal response and survival rates using conventional surgical and systemic options. Additionally, the ability to detect and monitor residual disease with current imaging modalities remains difficult. Therefore, advances in multimodal management and disease monitoring are desperately needed. We present a case of advanced PSCC utilizing multimodal management informed by next-generation sequencing and circulating tumor DNA monitoring. These genomic techniques were valuable in guiding management and deserve further evaluation in the management of PSCC and other rare malignancies.
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Affiliation(s)
- Levi C Holland
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas S Gerald
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Bailey Brooks
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
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11
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Pecoraro A, Elst L, Roussel E, Miletić M, Vanthoor J, De Ridder D, Van Rompuy AS, De Cuyper E, Dumez H, De Meerleer G, de Wever L, Goffin K, Van Poppel H, Joniau S, Albersen M. Impact of the Standardization of Penile Cancer Care on the Quality of Care, Outcomes, and Academic-driven Centralization in a Single eUROGEN Referral Center. Eur Urol Focus 2024; 10:57-65. [PMID: 37537111 DOI: 10.1016/j.euf.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/17/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Penile cancer (PeCa) represents a diagnostic and therapeutic challenge given the low patient volume, which may result in inadequate physician expertise and poor guideline adherence. Since 2015, we have developed a specific care pathway for PeCa in our tertiary referral center. OBJECTIVE To evaluate the impact of a dedicated PeCa care pathway on patient management, the adequacy of pathological reporting, and oncological outcomes. DESIGN, SETTING, AND PARTICIPANTS We retrospectively queried our institutional registry (S-66482) to identify patients who were surgically treated for PeCa between January 1989 and April 2022. The patient numbers were evaluated within a broader national context. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We compared patient, surgery, tumor, and pathological data before and after 2015. Kaplan-Meier analysis was used to compare local and regional recurrence rates and cancer-specific survival (CSS). RESULTS AND LIMITATIONS Overall, 313 patients were included, of whom 204 (65.1%) were surgically treated after 2015. The median number of patients treated yearly was significantly higher after 2015 (26 vs 5; p < 0.01). Patients treated after 2015 more frequently had no palpable lymph nodes at diagnosis, despite similar primary tumor stage. After adoption of the PeCa care pathway, organ-sparing surgery (OSS) was more commonly performed (79.9% vs 57.8%; p < 0.01) despite local staging being similar and without observing a significant increase in positive margins. Surgical staging in patients with European Association of Urology intermediate- or high-risk tumors was conducted more frequently after 2015 (90% vs 41%; p < 0.01). Pathology reporting was standardized, and there was more frequent reporting of p16 staining status (81.4% vs 8.3%; p < 0.01), lymphovascular invasion (93.8% vs 44.3%; p < 0.01), and perineural invasion (92.4% vs 44.3%; p < 0.01) following implementation. CONCLUSIONS Implementation of a standardized care pathway for PeCa resulted in higher rates of OSS and pathological nodal staging and more complete pathology reports. Considering that these changes were associated with an increase in the number of patients treated, academic-driven centralization may play a role in optimizing the management of these patients. PATIENT SUMMARY We evaluated the impact of a care pathway for patients with penile cancer on patient management, the completeness of pathology reporting, and cancer control. We found that implementation of this pathway was associated with an increase in the number of patients treated, higher rates of organ-sparing surgery and lymph node staging, and more complete pathology reports. Centralization of care may play a role in optimizing the management of penile cancer.
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Affiliation(s)
- Alessio Pecoraro
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Laura Elst
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Marija Miletić
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Clinical Department of Oncology and Nuclear Medicine, Sisters of Mercy University Hospital Center, Zagreb, Croatia
| | - Joren Vanthoor
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium; Department of Quality Improvement, University Hospitals Leuven, Leuven, Belgium
| | | | - Eline De Cuyper
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Herlinde Dumez
- Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth de Wever
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Karolien Goffin
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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12
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Zhou XL. Long-term follow-up of comparative study of open and endoscopic lymphadenectomy in patients with penile carcinoma. Surg Endosc 2024; 38:179-185. [PMID: 37950029 PMCID: PMC10776462 DOI: 10.1007/s00464-023-10542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Penile carcinoma is an uncommon cancer that develops in the penis tissue. The standard surgical method to manage regional lymph nodes after local excision is radical inguinal lymphadenectomy, but it has a high rate of complications. The objective of this retrospective study was to compare the long-term outcomes of endoscopic inguinal lymphadenectomy and open inguinal lymphadenectomy in patients with penile carcinoma. METHODS The study included patients diagnosed with penile carcinoma who underwent open inguinal lymphadenectomy (n = 23) or endoscopic inguinal lymphadenectomy (n = 27) at a single hospital between January 2013 and January 2021. Operation time, blood loss, drainage, hospital stay, postoperative complications, and survival rates were assessed and compared between the two groups. RESULTS The two groups were comparable in terms of age, tumor size and stage, inguinal lymph nodes, and follow-up. The endoscopic group had significantly lower blood loss (27.1 ± 1.5 ml vs 55.0 ± 2.7 ml, P < 0.05), shorter drainage time and hospital stay (4.7 ± 1.1 days vs 8.1 ± 2.2 days, and 13.4 ± 1.0 days vs 19 ± 2.0 days, respectively, P < 0.05), and longer operation time compared to the open group (82.2 ± 4.3 min in endoscopic group vs 53.1 ± 2.2 min in open group, P < 0.05). There were significant differences in the incidence of incisional infection, necrosis, and lymphorrhagia in both groups (4 vs 0, 4 vs 0, and 2 vs 0, respectively, P < 0.05). The inguinal lymph node harvested was comparable between the two groups. The mean follow-up time was similar for both groups (60.4 ± 7.7 m vs 59.8 ± 7.3 m), and the recurrence mortality rates were not significantly different. CONCLUSIONS The study shows that both open and endoscopic methods work well for controlling penile carcinoma in the long term. But the endoscopic approach is better because it has fewer severe complications. So, the choice of surgery method might depend on factors like the surgeon's experience, what they like, and what resources are available.
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Affiliation(s)
- Xue-Lu Zhou
- Department of Surgery, Chashan Hospital of Guangdong Medical University, 92 Caihong Road, Chashan Town, Dongguan, 523127, Guangdong, People's Republic of China.
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13
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Cilio S, Tufano A, Pezone G, Alvino P, Spena G, Pandolfo SD, Del Prete P, Amato C, Damiano R, Salonia A, Autorino R, Izzo A, Passaro F, Perdonà S. Sexual Outcomes after Conservative Management for Patients with Localized Penile Cancer. Curr Oncol 2023; 30:10501-10508. [PMID: 38132399 PMCID: PMC10742874 DOI: 10.3390/curroncol30120765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Men with localized invasive penile cancer (PC) can be treated with organ-sparing treatments with different functional and aesthetical outcomes. Thus, the aim of this study is to investigate sexual outcomes in patients with PC confined to the glans that underwent wide local excision (WLE) vs. glansectomy with urethral glanduloplasty. METHODS Complete data from 60 patients with PC were analyzed at our institution from 2017 to 2022. Patients were asked for personal habits and clinical features. PC was assessed with a clinical visit and imaging techniques. At the outpatient follow-up visit or phone call, all patients compiled the Changes in Sexual Function Questionnaire (CSFQ) and the International Index of Erectile Function in its short 5-item form (IIEF-5). Erectile function (EF) impairment was categorized using Cappelleri's criteria. RESULTS Overall, 34 patients with PC confined to the glans (c ≤ T2N0) were included. Of those, 12 underwent WLE and 22 underwent glansectomy with urethral glanduloplasty. Using multivariable logistic regression, glansectomy (OR: 3.49) and diabetes (OR: 2.33) were associated with erectile disfunction (IEEF < 22). Meanwhile, using multivariable linear regression analysis, younger patients (Coeff: -2.41) and those that underwent glansectomy (Coeff: -7.5) had a higher risk of sexual function impairment, according to the CSFQ. CONCLUSIONS Patients with PC ≤ T2N0 that underwent WLE have better outcomes in terms of sexual functioning than the patients who underwent glansectomy and uretheral gladuloplasty. Further research is needed to clarify the outcomes of penile-sparing surgery, to inform patients in pre-surgical counseling more comprehensively, and to meet their post-operative expectations more effectively.
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Affiliation(s)
- Simone Cilio
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Antonio Tufano
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” Rome University, 00161 Rome, Italy
| | - Gabriele Pezone
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Pierluigi Alvino
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Gianluca Spena
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Savio Domenico Pandolfo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Paola Del Prete
- Scientific Directorate, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
| | - Claudio Amato
- Dipartimento di Chimica e Tecnologia del Farmaco, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Rocco Damiano
- Urology Unit, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Andrea Salonia
- Unit of Urology/Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele, 20141 Milan, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA
| | - Alessandro Izzo
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
| | - Francesco Passaro
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
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14
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Tekin B, Cheville JC, Herrera Hernandez L, Negron V, Smith CY, Jenkins SM, Dasari S, Enninga EAL, Norgan AP, Menon S, Cubilla AL, Whaley RD, Jimenez RE, Thompson RH, Leibovich BC, Karnes RJ, Boorjian SA, Pagliaro LC, Erickson LA, Guo R, Gupta S. Assessment of PD-L1, TROP2, and nectin-4 expression in penile squamous cell carcinoma. Hum Pathol 2023; 142:42-50. [PMID: 37977513 DOI: 10.1016/j.humpath.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES There is an unmet need for therapeutically relevant biomarkers for advanced penile squamous cell carcinoma (pSCC). Proposed immunohistochemistry (IHC)-based biomarkers include programmed death-ligand 1 (PD-L1), trophoblast cell-surface antigen 2 (TROP2), and nectin-4; however, there is a paucity of data pertaining to these biomarkers. Herein, we investigated the expression of PD-L1, TROP2, and nectin-4 in a well-annotated cohort of pSCCs. METHODS A single-institution pathology archive was queried for patients who had a partial or total penectomy for pSCC between January 2000 and December 2022. Whole-slide sections were stained with antibodies against PD-L1 (22C3), TROP2, and nectin-4. Expression in tumor cells was quantified using H-scores (0-300). Associations between IHC expression, human papilloma virus (HPV) status, clinicopathologic findings, and outcome parameters were evaluated. RESULTS This study included 121 patients. For PD-L1, the median combined positive and H-scores were 1 and 0, respectively; 32.7 % of the cases had an H-score>0. Compared to PD-L1-negative tumors, PD-L1-positive tumors had higher pT stage and grade. The median TROP2 and nectin-4 H-scores were 230 and 140, respectively, with high TROP2 and nectin-4, defined by an H-score>200, noted in 80.7 % and 10.9 % of cases, respectively. High-risk HPV-positive cases had higher TROP2 and nectin-4 scores compared to HPV-negative cases. Patients with high TROP2 expression had significantly more disease progression, and patients with high nectin-4 expression had significantly fewer deaths due to disease. CONCLUSIONS High expression of TROP2 and nectin-4 in pSCC support evaluation of these markers as therapeutic targets pending validation of our findings.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | - Vivian Negron
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Carin Y Smith
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - Surendra Dasari
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | | | - Andrew P Norgan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - Antonio L Cubilla
- Instituto de Patología e Investigación, Universidad Nacional de Asunción, Asunción, Paraguay.
| | - Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | | - Lance C Pagliaro
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN, USA.
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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15
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da Silva TCL, Ximenes ÉGP, Santos YHDS, Araújo RJ, de Macedo EAB, de Medeiros KS, Araújo-Filho I. Epidemiological study of penile cancer in a northeastern state - Brazil. Rev Col Bras Cir 2023; 50:e20233586. [PMID: 37971116 PMCID: PMC10626489 DOI: 10.1590/0100-6991e-20233586-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/31/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE to trace the clinical and epidemiological profile of penile cancer in Rio Grande do Norte/Brazil and relate them to data published in the literature. METHODS a cross-sectional study was conducted with 94 patients diagnosed with penile cancer in 2011-2018, treated at the Liga Norte Riograndense Contra o Cancer. RESULTS all patients were diagnosed with squamous cell carcinoma, mainly aged over 50 years, from the states interior, brown, illiterate, or with incomplete primary education. At diagnosis, 68% of patients were classified as having tumors =T2, and 30% had lymph node involvement. Distant metastases were detected in 2.1% of patients at diagnosis. Most patients received the diagnosis in the initial phase of the disease, but 20.2% were diagnosed in stage IV. Partial penectomy was the most performed surgery, and 10% of patients relapsed, mainly in the lymph nodes (87.5%). The mean follow-up of the patients was 18 months, with an estimated overall survival at five years of 59.1%. However, 25% of patients were followed up for up to 3 months, losing follow-up. CONCLUSION the State of Rio Grande do Norte has a high incidence of penile cancer with a high frequency of locally advanced tumors at diagnosis and in younger patients younger than 50. Furthermore, socioeconomic factors interfere with early diagnosis and hinder access to specialized services.
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Affiliation(s)
| | | | | | | | | | | | - Irami Araújo-Filho
- - Universidade Federal do Rio Grande do Norte, Departamento de Cirurgia - Natal - RN - Brasil
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16
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Croghan SM, Cullen IM, Raheem O. Functional outcomes and health-related quality of life following penile cancer surgery: a comprehensive review. Sex Med Rev 2023; 11:441-459. [PMID: 37204120 DOI: 10.1093/sxmrev/qead021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Organ-sparing surgery (OSS) in penile cancer management aspires to maintain organ form and function and preserve health-related quality of life (HRQoL), yet there is a lack of integrated evidence exploring these outcomes. OBJECTIVES The aim sought to review HRQoL, functional, aesthetic, and psychological outcomes following OSS or radical penectomy for penile cancer. METHODS A systematic review of MEDLINE and Cochrane databases included studies reporting on function (sexual, urinary or sensory), genital appearance or HRQoL/psychological well-being following surgical treatment of primary penile cancer. English-language reports (2000-2022), incorporating patient-reported or objective clinical outcome measures, were eligible. Studies of nonsurgical treatment strategies and those in the context of metastatic disease were excluded. Data were compiled and analyzed. RESULTS Twenty-six studies were included. Sexual function was the most studied outcome (754 pooled respondents; 19 studies), most frequently with the original 15-item and abridged 5-item International Index of Erectile Function. Preservation of erectile function following OSS is generally described, with some reduction in overall sexual satisfaction cited. Heterogeneous assessment of voiding function with little preoperative evaluation render interstudy comparison difficult. Most patients appear able to void from a standing position following OSS, with spraying the most common symptom. Maintenance of some sensory function is described with both split-thickness skin grafting and urethral glanduloplasty following radical glansectomy. Limited studies suggest reasonable patient satisfaction with genital cosmesis post-OSS. A negative impact on HRQoL is described in most studies following penile cancer surgery, variably correlated with aggressiveness of penile surgery and addition of lymphadenectomy. Anxiety, depression, and reduced self-esteem have been reported in penile cancer survivors. Relationship well-being varies, with some survivors reporting this to be unchanged. CONCLUSION OSS can preserve elements of sexual, urinary, and sensory function, supporting advantages over radical penectomy for eligible patients. However, a comprehensive understanding remains limited due to small, heterogeneous patient cohorts, challenges in obtaining premorbid data, and variability in outcome measures. Standardization of patient-reported outcomes following OSS is desirable.
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Affiliation(s)
- Stefanie M Croghan
- Department of Surgery, Royal College of Surgeons, Dublin D02 YN77, Ireland
- Department of Urology, Blackrock Clinic, Dublin A94 E4X7, Ireland
| | - Ivor M Cullen
- Department of Urology, Blackrock Clinic, Dublin A94 E4X7, Ireland
- Department of Urology, Beaumont Hospital, Dublin D09V2N0, Ireland
| | - Omer Raheem
- Department of Surgery, Section of Urology, University of Chicago Medicine, Chicago, IL 60637, United States
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Muheilan M, Sharif A, MacCraith E, Alhajahjeh R, Power D, Hennessey D, Sweeney P. Smoking is an independent risk factor for skin flap complications following inguinal lymph node dissection for penile cancer. Ir Med J 2023; 116:835. [PMID: 37791702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
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18
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Bakshi GK, Pal M, Jain DK, Arora A, Tamhankar A, Maitre P, Murthy V, J A, Agrawal A, Menon S, Joshi A, Spiess PE, Prakash GJ. Surgical templates for inguinal lymph node dissection in cN0 penile cancer: A comparative study. Urol Oncol 2023; 41:393.e9-393.e16. [PMID: 37507285 DOI: 10.1016/j.urolonc.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/04/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Modified and superficial inguinal lymph node dissection (MILD and SILD) are the 2 widely used templates for surgical staging of clinically node negative (cN0) penile cancer (PeCa); however, no previous reports have compared their outcomes. We compared these 2 surgical templates for oncological outcomes and complications. MATERIALS AND METHODS We retrospectively reviewed records of cN0 PeCa patients who underwent MILD/SILD at our cancer care center from January 2013 to December 2019. Patients who developed a penile recurrence during follow up were excluded from analysis of oncological outcomes. The 2 groups (MILD and SILD) were compared for baseline clinico-pathological characteristics. The primary outcome was the groin recurrence free survival (gRFS). Secondary outcomes included the false negative rate (FNR) and disease free survival (DFS) for both templates and also the post-operative wound related complication. RESULTS Of the 146 patients with intermediate and high risk N0 PeCa, 74 (50.7%) and 72 (49.3%) underwent MILD and SILD respectively. The 2 groups were comparable with regards to the distribution of T stage, tumor grade and the proportion of intermediate and high-risk patients. At a median follow up of 34 months (47 for SILD and 23 for MILD), a total of 5 groin recurrences were encountered; all of them occurred in the MILD group. The gRFS and DFS for the MILD group was 93.2% and 91.8% respectively; while that for the SILD group was 100% and 94.4% respectively. Too few events had occurred to determine any statistically significant difference. The FNR for MILD and SILD was 26.3% and 0% respectively. The overall complication rate was significantly higher in the SILD group (46% vs 20.3%, p=0.001), especially for Clavien Dindo 3A complications. CONCLUSION MILD can fail to pick up micro-metastatic disease in a small proportion of cN0 PeCa patients, while SILD provides better oncological clearance with no groin recurrences. This oncological superiority comes at the cost of a higher incidence of wound-related complications.
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Affiliation(s)
- Ganesh K Bakshi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mahendra Pal
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deep Kumar Jain
- Assistant Professor, MGM Medical College and Super-speciality Hospital, Indore, India
| | - Amandeep Arora
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwin Tamhankar
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Priyamvada Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arunkumar J
- Department of Clinical Research, JIPMER, Puducherry, India
| | - Archi Agrawal
- Department of Nuclear Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre, Mumbai, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Gagan J Prakash
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
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Campos MAG, Teixeira AAL, Calixto JDRR, Larges JS, Pinho JD, Silva GEB. Predictive histopathological factors of nodal metastasis in penile cancer. Int Braz J Urol 2023; 49:628-636. [PMID: 37351908 PMCID: PMC10482464 DOI: 10.1590/s1677-5538.ibju.2022.0640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
- Marcos Adriano Garcia Campos
- Universidade Estadual PaulistaFaculdade de MedicinaBotucatuSPBrasilFaculdade de Medicina da Universidade Estadual Paulista - Unesp, Botucatu, SP, Brasil
| | - Antonio Augusto Lima Teixeira
- Hospital Universitário Presidente DutraLaboratório de Imunofluorescência e Microscopia EletrônicaSão LuísMABrasilLaboratório de Imunofluorescência e Microscopia Eletrônica, Hospital Universitário Presidente Dutra, São Luís, MA, Brasil
- Universidade de São PauloDepartamento de GenéticaRibeirão PretoSPBrasilDepartamento de Genética, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - José de Ribamar Rodrigues Calixto
- Universidade Federal do MaranhãoDepartamento de Medicina IISão LuísMABrasilDepartamento de Medicina II, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - Joyce Santos Larges
- Hospital Universitário Presidente DutraLaboratório de Imunofluorescência e Microscopia EletrônicaSão LuísMABrasilLaboratório de Imunofluorescência e Microscopia Eletrônica, Hospital Universitário Presidente Dutra, São Luís, MA, Brasil
| | - Jaqueline Diniz Pinho
- Hospital Universitário Presidente DutraLaboratório de Imunofluorescência e Microscopia EletrônicaSão LuísMABrasilLaboratório de Imunofluorescência e Microscopia Eletrônica, Hospital Universitário Presidente Dutra, São Luís, MA, Brasil
- Universidade Estadual do MaranhãoZé DocaMABrasilUniversidade Estadual do Maranhão, Zé Doca, MA, Brasil
| | - Gyl Eanes Barros Silva
- Hospital Universitário Presidente DutraLaboratório de Imunofluorescência e Microscopia EletrônicaSão LuísMABrasilLaboratório de Imunofluorescência e Microscopia Eletrônica, Hospital Universitário Presidente Dutra, São Luís, MA, Brasil
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Tobias-Machado M, Ornellas AA, Hidaka AK, Medina LG, Mattos PAL, Besio RS, Abreu D, Castro PR, Nishimoto RH, Astigueta J, Dourado A, Machado RD, Magnabosco WJ, Corona-Montes V, Villoldo GM, Zampolli HC, Taha A, Auad PR, Faria EF, Arantes PBO, Tavares A, Nascimento FSMS, Brazão ES, Rocha MM, Costa WH, Panico V, Reis LO, Almeida-Carrera RJ, Silva RC, Zequi SC, Calixto JRR, Sotelo R. Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer. Int Braz J Urol 2023; 49:580-589. [PMID: 37390124 PMCID: PMC10482462 DOI: 10.1590/s1677-5538.ibju.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). MATERIALS AND METHODS Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. RESULTS From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. CONCLUSION VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.
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Affiliation(s)
- Marcos Tobias-Machado
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
- Centro Universitário Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | | | - Alexandre K Hidaka
- Centro Universitário Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | - Luis G Medina
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pablo A L Mattos
- Associação Piauiense de Combate ao Câncer - Hospital São Marcos, Teresina, PI, Brasil
| | | | | | | | | | - Juan Astigueta
- Universidad Privada Antenor Orrego, Instituto Regional de Enfermedades Neoplásicas Norte, Trujillo, Perú
| | - Aurus Dourado
- Associação Piauiense de Combate ao Câncer - Hospital São Marcos, Teresina, PI, Brasil
| | | | | | | | | | | | - Anis Taha
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | - Pericles R Auad
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | | | | | | | | | | | | | - Walter H Costa
- AC Camargo Cancer Center, São Paulo, SP, Brasil
- National Institute for Science and Technology in Ocogenomic and Therapeutic Innovation INCIT/INOTE AC Camargo Cancer Center, São Paulo, SP, Brasil
| | | | - Leonardo O Reis
- UroScience, Escola de Ciências Médicas, Universidade de Campinas - UNICAMP, Campinas, SP, Brasil
- Pontifícia Universidade Católica de Campinas - PUC, Campinas, SP, Brasil
| | | | - Rafael C Silva
- Universidade Federal do Maranhão - UFMA, Maranhão, MA, Brasil
| | - Stênio C Zequi
- AC Camargo Cancer Center, São Paulo, SP, Brasil
- National Institute for Science and Technology in Ocogenomic and Therapeutic Innovation INCIT/INOTE AC Camargo Cancer Center, São Paulo, SP, Brasil
| | | | - Rene Sotelo
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Yamaguchi T, Goya M, Higashijima K, Tobu S, Sato R, Tatarano S, Mukai S, Uemura KI, Tatsugami K, Tsubouchi K, Shida Y, Ishii T, Sakai H, Matsuoka H, Haga N, Eto M, Igawa T, Kamoto T, Enokida H, Shin T, Noguchi M, Fujimoto N, Saito S, Kamba T. Real-world treatment outcomes of patients with penile cancer in the Kyushu-Okinawa area of Japan in the pre-guideline era. Jpn J Clin Oncol 2023; 53:837-844. [PMID: 37282601 DOI: 10.1093/jjco/hyad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/16/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVES To understand the real-world outcomes for patients with penile cancer in the Kyushu-Okinawa area before the introduction of practice guidelines in Japan. METHODS We retrospectively collected medical information on patients with penile squamous cell carcinoma and penile intraepithelial neoplasia at 12 university hospitals and their affiliated hospitals in the Kyushu-Okinawa area from January 2009 to December 2020. Patients with unknown clinical stage were excluded. Patient background characteristics and survival, as well as pretreatment factors involved in survival, were investigated. RESULTS A total of 196 patients were included. Patients with clinical stage 0, I, IIA, IIB, IIIA, IIIB and IV comprised 9.7, 26.0, 22.4, 2.6, 10.7, 14.3 and 14.3%, respectively. The median follow-up was 26 months, and the mean 5-year overall survival and cancer-specific survival rates were 74.3 and 79.8%, respectively. On univariate analysis, tumor diameter ≥ 30 mm, penile shaft tumor, Eastern Cooperative Oncology Group performance status ≥ 1, cT ≥ 3, cN ≥ 2 and cM1 were associated with significantly poorer cancer-specific survival. On multivariate analysis, pretreatment factors of cN ≥ 2 (hazard ratio, 32.5; 95% confidence interval, 5.08-208; P = 0.0002), Eastern Cooperative Oncology Group performance status ≥ 1 (4.42; 1.79-10.9; P = 0.0012) and cT ≥ 3 (3.34; 1.11-10.1; P = 0.0319) were identified as independent prognostic factors. CONCLUSIONS The study revealed basic data for future penile cancer treatment and research, including survival rates according to clinical stages, and identified cN ≥ 2, Eastern Cooperative Oncology Group performance status ≥ 1 and cT ≥ 3 at initial diagnosis as independent prognostic factors. Evidence for penile cancer in Japan is particularly scarce, and future large-scale prospective studies are warranted.
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Affiliation(s)
- Takahiro Yamaguchi
- Department of Urology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Masato Goya
- Department of Urology, Chubu Tokushukai Hospital, Kitanakagusuku, Okinawa, Japan
| | - Katsuyoshi Higashijima
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Shohei Tobu
- Department of Urology, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Ryuta Sato
- Department of Urology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Shuichi Tatarano
- Department of Urology, Faculty of Medicine, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Shoichiro Mukai
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Kei-Ichiro Uemura
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Katsunori Tatsugami
- Department of Urology, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan
| | - Kazuna Tsubouchi
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Yohei Shida
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Tatsu Ishii
- Department of Urology, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Hideki Sakai
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Hirofumi Matsuoka
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Nobuhiro Haga
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Tsukasa Igawa
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Toshiyuki Kamoto
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Hideki Enokida
- Department of Urology, Faculty of Medicine, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Toshitaka Shin
- Department of Urology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Mitsuru Noguchi
- Department of Urology, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Naohiro Fujimoto
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Seiichi Saito
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Tomomi Kamba
- Department of Urology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
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Kumar V, Kumar PR, Juette A, Pawaroo D, Ball RY, Sethia KK. Improved outcome in penile cancer with radiologically enhanced stratification protocol for lymph node staging procedures: a study in 316 inguinal basins with a mean follow-up of 5 years. BMC Urol 2023; 23:137. [PMID: 37582745 PMCID: PMC10426083 DOI: 10.1186/s12894-023-01303-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/20/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Lymph node metastasis is the main determinant of survival in penile cancer patients. Conventionally clinical palpability is used to stratify patients to Inguinal Lymph node dissection (ILND) if clinically node positive (cN +) or Dynamic sentinel node biopsy (DSNB) if clinically node negative (cN0). Studies suggest a false negative rate (FNR) of around 10% (5-13%) for DSNB. To our knowledge there are no studies reporting harder end point of survival and outcomes of all clinically node positive (cN +) patients. We present our outcome data of all patients with penile cancer including false negative rates and survival in both DSNB and ILND groups. METHODS One hundred fifty-eight consecutive patients (316 inguinal basins), who had lymph node surgery for penile cancer in a tertiary referral centre from Jan 2008 to 2018, were included in the study. All patients underwent ultrasound (US) ± fine needle aspiration cytology (FNAC) and then MRI/ CT, if needed, to stage their disease. We used combined clinical and radiological criteria (node size, architecture loss, irregular margins) to stratify patients to DSNB vs ILND as opposed to clinical palpability alone. RESULTS 11.2% i.e., 27/241 inguinal basins had lymph node positive disease by DSNB. 54.9% i.e., 39/71 inguinal basins (IBs) had lymph node-positive disease by ILND. 4 inguinal basins with no tracer uptake in sentinel node scans are being monitored at patient's request and have not had any recurrences to date. With a mean follow-up of 65 months (range 24-150), the false-negative rate (FNR) for DSNB is 0%. Judicious uses of cross-sectional imaging necessitated ILND in 2 inguinal basins with non-palpable nodes and negative US with false positive rate of 6.3% (2/32) for ILND. The same cohort of DSNB patients might have had 11.1% (3/27) FNR if only palpability criteria was used. 43 (28%) patients who did require cross sectional imaging as per our criteria had a low node positive rate of 4.7% (p = 0.03). Mean cancer specific survival of all node-positive patients was 105 months. CONCLUSION The performance of DSNB improved with enhanced radiological stratification of patients to either DSNB or ILND. We for the first time report the comprehensive outcome of all lymph node staging procedures in penile cancer.
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Affiliation(s)
- Vivekanandan Kumar
- Department of Urology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, NR4 7UY, UK.
| | - Prakrit R Kumar
- Department of Urology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, NR4 7UY, UK
| | - Arne Juette
- Department of Urology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, NR4 7UY, UK
| | - Davina Pawaroo
- Department of Urology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, NR4 7UY, UK
| | - Richard Y Ball
- Department of Urology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, NR4 7UY, UK
| | - Krishna K Sethia
- Department of Urology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, NR4 7UY, UK
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23
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Wang LX, Zhang C, Yue DZ, Ge JP, Xu S, Dong J. [Clinical appraisal of laparoscopic inguinal lymphadenectomy with preservation of the great saphenous vein through subcutaneous approach via umbilical cord for the treatment of penile carcinoma: Report of 27 cases]. Zhonghua Nan Ke Xue 2023; 29:721-724. [PMID: 38619519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To explore the clinical efficacy and advantages of laparoscopic inguinal lymphadenectomy (IL) with preservation of the great saphenous vein through subcutaneous approach via umbilical cord for the treatment of penile carcinoma patients. METHODS The data of 27 patients with penile cancer underwent the laparoscopic inguinal lymph adenectomy with preservation of the great saphenous vein through subcutaneous via umbilical cord approach in the General Hospital of Eastern Theater Command from 2014 May to 2022 May were analyzed retrospectively.All patients underwent partial penile resection, with a pathological diagnosis of squamous cell carcinoma and 20 cases were highly differentiated, 7 cases were moderately differentiated, with the average age was 54 ± 7.5 years old. All patients were in supine position, and a subcutaneous space was established under visualization to establish a laparoscopic operation channel. The scope of cleaning included the superficial and deep inguinal lymph nodes, while the key aspects of the procedure was the preservation of the main trunk of the great saphenous vein. The external boundary of bilateral inguinal lymph node dissection was the line between the anterior superior iliac spine and 20cm lower, the inner boundary was pubic tubercle and its 15cm medical lower measurement, and the line between the inner boundary and the external lower edge was the lower boundary. RESULT All the 27 patients were successfully completed without transfer to open surgery. The average operation time was (115 ± 26) minutes, the average blood loss during operation was (40 ± 8) ml, postoperative hospital stays was (6.8 ± 1.5) days, and postoperative drainage tube removal time was (6.4 ± 1.2) days. The average number of lymph nodes was 12.5 (5-21) on the left side, and 11.4 (2-19) on the right side. No skin necrosis and subcutaneous hematoma was occurred in all patients. Three patients had postoperative lymphatic leakage and two patients had lymphatic cysts. All patients were cured by conservation treatment. No recurrence and metastasis were occurred during 14-28 months follow up postoperatively. Conclusion: Laparoscopic inguinal lymphadenectomy with preservation of the great saphenous vein through subcutaneous approach via umbilical cord can achieve the expected surgical outcome. It has some advantages of shorter operation time, less blood loss,low incidence of complication ,especially avoid skin flap necrosis and subcutaneous hematoma..
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Affiliation(s)
- Long-Xin Wang
- Department of Urology, The First Affiliated Hospital of China Pharmaceutical University, Nanjing, iangsu, 211198, China
| | - Chao Zhang
- Department of Urology, The First Affiliated Hospital of China Pharmaceutical University, Nanjing, iangsu, 211198, China
| | - De-Zhou Yue
- Department of Urology, The First Affiliated Hospital of China Pharmaceutical University, Nanjing, iangsu, 211198, China
| | - Jin-Ping Ge
- Department of Urology, General Hospital of Eastern Theater Command, Nanjing, Jiangsu 210002, China
| | - Song Xu
- Department of Urology, General Hospital of Eastern Theater Command, Nanjing, Jiangsu 210002, China
| | - Jie Dong
- Department of Urology, General Hospital of Eastern Theater Command, Nanjing, Jiangsu 210002, China
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24
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Candelario NC, Molina E, Bourlon MT, Kim SP, Kessler ER, Spiess PE, Flaig TW. Racial differences in survival for early stage (T1) penile cancer: Analysis from the SEER database. Urol Oncol 2023; 41:359.e15-359.e23. [PMID: 37344326 PMCID: PMC10658609 DOI: 10.1016/j.urolonc.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/21/2023] [Accepted: 05/19/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Penile cancer accounts for less than 1% of male cancers in the United States. Localized disease, particularly T1 tumors are potentially curable with local therapy. We present the racial differences in survival outcomes for T1, penile cancer from the SEER database. METHODS From 2004 to 2016 all men with T1, N0, M0 penile cancer in the SEER-18 database were included. Kaplan-Meier analysis and multivariable Cox-Regression analysis were conducted to investigate prognostic variables for cancer specific survival (CSS). RESULTS A total of 4,406 men were identified with penile cancer; 1,941 men had T1 disease. The Kaplan-Meier (KM) analysis showed those with primary site surgery had better 5-year CSS compared to those without primary site surgery (P <.0001) and a significant difference in CSS based on race (P= 0.0078). On multivariable analysis, Hispanic individuals had worse CSS (HR 1.92; P = 0.0057) compared to the White men. Black men were also found to have a poor CSS however this was not statistically significant (HR 1.53, P = 0.118). Men with penile cancer who had either penectomy (HR 0.45; P = 0.006) or penile preservation surgery (HR 0.25; P< 0.001) had improved CSS. CONCLUSION Racial disparities in CSS exist among men with in early-stage penile cancer. KM analysis showed significant differences in CSS by race and in those receiving primary site surgery. On multivariable analysis, the CSS is worse in Hispanic compared to White men. There is a trend towards worse CSS in Black men however this was not statistically significant.
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Affiliation(s)
- Nellowe C Candelario
- Division of Medical Oncology, University of Colorado Cancer Center Anschutz Medical Campus, Aurora, CO
| | - Elizabeth Molina
- Division of Medical Oncology, University of Colorado Cancer Center Anschutz Medical Campus, Aurora, CO
| | - Maria T Bourlon
- Hemato-Oncology Deparment, Urologic Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Simon P Kim
- Division of Urology, University of Colorado Cancer Center Anschutz Medical Campus, Aurora, CO
| | - Elizabeth R Kessler
- Division of Medical Oncology, University of Colorado Cancer Center Anschutz Medical Campus, Aurora, CO
| | - Philippe E Spiess
- Department of GU Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, FL
| | - Thomas W Flaig
- Division of Medical Oncology, University of Colorado Cancer Center Anschutz Medical Campus, Aurora, CO.
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25
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O'Kelly JA, Browne E, Daly P, Keane J, Shah N, Shilling C, Cullen IM. Penile cancer in younger men-A more aggressive disease? Urol Oncol 2023; 41:329.e11-329.e15. [PMID: 37225633 DOI: 10.1016/j.urolonc.2023.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Penile cancer (PC) in men under 45 is very rare with an incidence of 0.1 to 0.8/100,000. There is little published data on disease characteristics and outcomes of PC in younger men. Herein, we evaluate the disease characteristics and outcomes of penile cancer in younger men compared to an older cohort. METHODS This study included all men diagnosed with PC at our institution from 2016 to 2021. Primary outcomes included overall survival, cancer-specific survival, and disease-free survival. Secondary outcomes included disease characteristics and surgical management. Men aged ≤45 years (Group A) were compared with men aged >45 years (Group B) at diagnosis. RESULTS There were 90 patients treated for invasive PC over the study period. The median age at diagnosis was 64 (26-88). The mean length of follow-up was 27 (±18) months. There were 12 (13%) in Group A, and 78 (87%) patients in Group B. Group A had a worse cancer-specific survival compared to Group B (39 months vs. not reached, HR 0.1 (95%CI 0.02-0.85, P = 0.03). There was no significant difference in overall or disease-free survival between both groups. More men in Group A had lymph node metastases at the time of diagnosis (58% vs. 19%, P < 0.001). There was no significant difference in histopathological features including tumor subtype, grade, T stage, p53 status or presence of lymphovascular or perineural invasion. CONCLUSION In our study, younger men were more likely to have nodal involvement at time of diagnosis and had a worse cancer-specific survival.
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Affiliation(s)
- John A O'Kelly
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland.
| | - Eva Browne
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Padraig Daly
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland; Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - John Keane
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Nigam Shah
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Christine Shilling
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Ivor M Cullen
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland; Royal College of Surgeons in Ireland, Dublin, Republic of Ireland; Department of Urology, Beaumont Hospital, Dublin, Republic of Ireland
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26
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Falcone M, Preto M, Ferro I, Cirigliano L, Peretti F, Plamadeala N, Scavone M, Lavagno F, Oderda M, Gontero P. Surgical and Functional Outcomes of Penile Amputation and Perineal Urethrostomy Configuration in Invasive Penile Cancer. Urology 2023; 177:227. [PMID: 37085051 DOI: 10.1016/j.urology.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The treatment of invasive penile cancer is based on partial or total penectomy and perineal urethrostomy configuration.1-3 To report surgical and functional outcomes of penile amputation and perineal urethrostomy configuration in a consecutive series of patients with invasive penile cancer. MATERIALS AND METHODS A single-center retrospective analysis was conducted from January 2018 to December 2022. Data were extracted from clinical records and operative notes. As primary outcomes, surgical complications were described. Oncological outcomes through cancer-specific survival and overall survival were analyzed. Patient survival was estimated by a Kaplan-Meier analysis. Functional outcomes were assessed through the administration of the International Prostatic Symptoms Score (IPSS) questionnaire at 3 months follow-up. RESULTS Overall 10 patients were enrolled. The median follow-up was 16 months (Interquartile range (IQR 12-18)). The median age was 71 years (IQR 63-79). Operative time was set at 195 minutes (IQR 155-275). The median hospital stay was 8 days (IQR: 6-10). Postoperative complications occurred in 20% of patients, in 1 case surgical revision was necessary. Positive surgical margins were detected only in 1 patient. The median catheterization time was 15 days (IQR: 15-32). One patient developed local recurrence. At 1 year, the cancer-specific survival was 80% and overall survival was 60%. The median preoperative IPSS was 15 (IQR 12-19). The median postoperative IPSS was 6 (IQR 5-7). CONCLUSION Penile amputation and perineal urethrostomy configuration was demonstrated to be a safe and effective procedure to address invasive penile cancer.
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Affiliation(s)
- Marco Falcone
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Mirko Preto
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy.
| | - Ilaria Ferro
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Lorenzo Cirigliano
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Federica Peretti
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Natalia Plamadeala
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Martina Scavone
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Federico Lavagno
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Marco Oderda
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy
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Liang Y, Xu LQ, Wang K, Yuan J, Wang X, Zu XB, Yu Y, Liu XM. [Double-channel expansion of the subcutaneous lower abdominal tunnel for sequential inguinal lymph node dissection in penile cancer - Report of six cases]. Zhonghua Nan Ke Xue 2023; 29:645-648. [PMID: 38619414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To investigate the safety and efficacy of the two-channel dilatation procedure for subcutaneous tunneling in the lower abdomen during pelvic lymph node dissection for penile cancer. METHODS A retrospective analysis was conducted on the clinical data of 6 patients treated from January 2020 to December 2022 using the dual-channel expansion technique for penile cancer lymph node dissection. RESULTS All 6 cases ( 12 sides) successfully underwent prophylactic inguinal lymph node dissection. The average laparoscopic dissection time was ( 82.50 ± 12.08) minutes per side, with an average blood loss of (28.33 ± 10.95) ml. The number of lymph nodes dissected was (11.16 ± 1.02) for the superficial group and ( 0.67 ± 0.74 ) for the deep group. Postoperative pathology was negative in all cases. The average postoperative hospital stay was (7.33 ± 1.60 ) days, with a catheter removal time of (12.00 ± 2.06)days. Postoperative complications included abnormal skin sensations in 5 sides, lower limb edema in 3 sides, lymphedema in 3 sides, and cellulitis in 1 side. During a follow-up period of (20.60 ± 12.51)months, there were no instances of tumor recurrence or metastasis in the inguinal region among the patients. CONCLUSION The dual-channel expansion technique for inguinal lymph node dissection via a subcutaneous tunnel is a safe and feasible treatment for penile cancer. It has a low complication rate, allows for thorough dissection of inguinal lymph nodes, and offers advantages in terms of surgical time.
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Affiliation(s)
- Yu Liang
- Department of Urology,The 906th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Ningbo, Zhejiang 315000, China
| | - Li-Qi Xu
- Department of Urology,The 906th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Ningbo, Zhejiang 315000, China
| | - Kai Wang
- Department of Urology,The 906th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Ningbo, Zhejiang 315000, China
| | - Jie Yuan
- Department of Urology,The 906th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Ningbo, Zhejiang 315000, China
| | - Xi Wang
- Department of Urology,The 906th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Ningbo, Zhejiang 315000, China
| | - Xiong-Bing Zu
- Department of Urology, Xiangya Hospital of Centralsouth University, Changsha, Hunan 410008, China
| | - Yi Yu
- Department of Urology, The First Affiliated Hospital Of Ningbo University, Ningbo, Zhejiang 315000, China
| | - Xing-Ming Liu
- Department of Urology,The 906th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Ningbo, Zhejiang 315000, China
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Shi CJ, Wu D, Zhang Y, Fu D, Tang CP, Shang XJ. [Keratoacanthoma of the penis: A case report and literature review]. Zhonghua Nan Ke Xue 2023; 29:523-526. [PMID: 38602725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To explore the clinical characteristics and treatment options of keratoacanthoma (KA) of the penis. METHODS We report the diagnosis and treatment of a case of penile keratoacanthoma in our hospital and review the literature. RESULTS The patient was admitted due to the discovery of a "new lesion on the glans for 4 months," diagnosed with a penile tumor, underwent tumor resection surgery, with histopathological examination revealing squamous epithelial hyperplasia, thickening, and excessive keratinization. The postoperative pathological diagnosis was penile keratoacanthoma. There was no recurrence or metastasis during follow-up. CONCLUSION KA is a relatively rare benign tumor with potential malignant transformation, and close follow-up is necessary postoperatively.
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Affiliation(s)
- Chang-Jie Shi
- Department of Urology, General Hospital of Eastern Theater Command, Nanjing, Jiangsu 210002, China
| | - Ding Wu
- Department of Urology, General Hospital of Eastern Theater Command, Nanjing, Jiangsu 210002, China
| | - Ying Zhang
- Department of Urology, General Hospital of Eastern Theater Command, Nanjing, Jiangsu 210002, China
| | - Dian Fu
- Department of Urology, General Hospital of Eastern Theater Command, Nanjing, Jiangsu 210002, China
| | - Chao-Peng Tang
- Department of Urology, General Hospital of Eastern Theater Command, Nanjing, Jiangsu 210002, China
| | - Xue-Jun Shang
- Department of Urology, General Hospital of Eastern Theater Command, Nanjing, Jiangsu 210002, China
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29
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Bada M, Crocetto F, Nyirady P, Pagliarulo V, Rapisarda S, Aliberti A, Boccasile S, Ferro M, Barone B, Celia A. Inguinal lymphadenectomy in penile cancer patients: a comparison between open and video endoscopic approach in a multicenter setting. J Basic Clin Physiol Pharmacol 2023; 34:383-389. [PMID: 36933235 DOI: 10.1515/jbcpp-2023-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/25/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES To compare differences of operative outcomes, post-operative complications and survival outcomes between open and laparoscopic cases in a multicenter study. METHODS This was a retrospective cohort study performed at three European centers from September 2011 to January 2019. The surgeon decision to perform open inguinal lymphadenectomy (OIL) or video endoscopic inguinal lymphadenectomy (VEIL) was done in each hospital after patient counselling. Inclusion criteria regarded a minimum follow-up of 9 months since the inguinal lymphadenectomy. RESULTS A total of 55 patients with proven squamous cell penile cancer underwent inguinal lymphadenectomy. 26 of them underwent OIL, while 29 patients underwent VEIL. For the OIL and VEIL groups, the mean operative time was 2.5 vs. 3.4 h (p=0.129), respectively. Hospital stays were lower in the VEIL group with 4 vs. 8 days in OIL patients (p=0.053) while number of days requiring drains to remain in situ was 3 vs. 6 days (p=0.024). The VEIL group reported a lower incidence of major complications compared to the OIL group (2 vs. 17%, p=0.0067) while minor complications were comparable in both groups. In a median follow-up period of 60 months, the overall survival was 65.5 and 84.6% in OIL and VEIL groups, respectively (p=0.105). CONCLUSIONS VEIL is comparable to OIL regarding safety, overall survival and post-operative outcomes.
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Affiliation(s)
- Maida Bada
- Department of Urology, San Bassanino Hospital, Bassano del Grappa, Vicenza, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology - Federico II University of Naples, Naples, Italy
| | - Peter Nyirady
- Department of Urology, Semmelweis University, Budapest, Budapest, Italy
| | - Vincenzo Pagliarulo
- Department of Urology, Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Sebastiano Rapisarda
- Department of Urology, Pederzoli Hospital Private Clinic SpA, Peschiera del Garda, Veneto, Italy
| | - Antonio Aliberti
- Urology, ASL 3 Napoli Castellammare di Stabia, Castellammare di Stabia, Italy
| | - Stefano Boccasile
- Department of Urology, Cima Barcelona Hospital, Barcelona, Catalogna, Spain
| | - Matteo Ferro
- Istituto Europeo di Oncologia, Milano, Lombardia, Italy
| | - Biagio Barone
- Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Campania, Italy
| | - Antonio Celia
- Department of Urology, San Bassanino Hospital, Bassano del Grappa, Veneto, Italy
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Han YF, Yao XH, Deng JW, Lai B, Zeng YM, Peng L, Tang ZJ, Wang C, Li JW. [Penile cancer with perineural invasion is more prone to postoperative recurrence]. Zhonghua Nan Ke Xue 2023; 29:337-341. [PMID: 38598218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To explore the correlation between perineural invasion and postoperative recurrence in patients surgically treated for penile cancer. METHODS We conducted a retrospective analysis of the clinical data on 18 penile cancer patients surgically treated in our hospital from January 2018 to December 2021, 8 with postoperative recurrence (the recurrence group) and the other 10 without (the non-recurrence control group). We compared the two groups of patients in the age of onset, tumor-node-metastasis (TNM) stages, American Joint Committee on Cancer (AJCC) prognosis stages, surgical methods, perineural invasion and recurrence time. We analyzed the differences in postoperative recurrence using the Kaplan Meier plotted survival curve and in independent risk factors in predicting postoperative recurrence using the ROC curve. RESULTS Compared with the non-recurrence controls, the patients in the recurrence group had a significantly older age of onset (P=0.0411) and severer perineural invasion (P<0.001), and those with perineural invasion had a shorter recurrence time (P<0.001), which was an independent risk factor for postoperative recurrence. The areas under the ROC curves for perineural invasion and age were 0.885 and 0.213, respectively. CONCLUSION Penile cancer with perineural invasion is more prone to and perineural invasion is an independent risk factor for postoperative recurrence of the malignancy.
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Affiliation(s)
- Yue-Fu Han
- Department of Urology, Yuebei People`s Hospital Affiliated to Shantou University School of Medicine, Shaoguan, Guangdong 512026, China
| | - Xin-Hua Yao
- Department of Cardiovascular Medicine, Yuebei People`s Hospital Affiliated to Shantou University School of Medicine, Shaoguan, Guangdong 512026, China
| | - Ji-Wang Deng
- Department of Urology, Yuebei People`s Hospital Affiliated to Shantou University School of Medicine, Shaoguan, Guangdong 512026, China
| | - Bin Lai
- Department of Urology, Yuebei People`s Hospital Affiliated to Shantou University School of Medicine, Shaoguan, Guangdong 512026, China
| | - Yong-Mao Zeng
- Department of Urology, Yuebei People`s Hospital Affiliated to Shantou University School of Medicine, Shaoguan, Guangdong 512026, China
| | - Lian Peng
- Department of Urology, Yuebei People`s Hospital Affiliated to Shantou University School of Medicine, Shaoguan, Guangdong 512026, China
| | - Zi-Jian Tang
- Department of Urology, Yuebei People`s Hospital Affiliated to Shantou University School of Medicine, Shaoguan, Guangdong 512026, China
| | - Chen Wang
- Department of Urology, Yuebei People`s Hospital Affiliated to Shantou University School of Medicine, Shaoguan, Guangdong 512026, China
| | - Jun-Wei Li
- Department of Urology, Yuebei People`s Hospital Affiliated to Shantou University School of Medicine, Shaoguan, Guangdong 512026, China
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Nazzani S, Catanzaro M, Biasoni D, Maccauro M, Stagni S, Torelli T, Macchi A, Bernasconi V, Taverna A, Sessa D, Lorenzoni A, Piva L, Lanocita R, Cascella T, Cattaneo L, Montanari E, Salvioni R, Nicolai N. Bilateral inguinal lymph-node dissection vs. unilateral inguinal lymph-node dissection and dynamic sentinel node biopsy in clinical N1 squamous cell carcinoma of the penis. Urol Oncol 2023; 41:210.e1-210.e8. [PMID: 36868883 DOI: 10.1016/j.urolonc.2023.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/10/2023] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION To evaluate the role of unilateral inguinal lymph-node dissection (ILND) plus contralateral dynamic sentinel node biopsy (DSNB) vs. bilateral ILND in clinical N1 (cN1) penile squamous cell carcinoma (peSCC) patients. MATERIAL AND METHODS Within our institutional database (1980-2020, included), we identified 61 consecutive cT1-4 cN1 cM0 patients with histological confirmed peSCC who underwent either unilateral ILND plus DSNB (26) or bilateral ILND (35). RESULTS Median age was 54 years (Interquartile range [IQR]: 48-60 years). Median follow-up was 68 months (IQR 21-105 months). Most patients had pT1 (23 %) or pT2 (54.1%), as well as G2 (47.5%) or G3 (23%) tumors, while lymphovascular invasion (LVI) was present in 67.1% of cases. Considering a cN1 and a cN0 groin, overall 57 out of 61 patients (93.5%) had nodal disease in the cN1 groin. Conversely, only 14 out of 61 patients (22.9%) had nodal disease in the cN0 groin. 5-year IR-free survival was 91% (Confidence interval [CI] 80%-100%) for bilateral ILND group and 88% (CI 73%-100%) for the ipsilateral ILND plus DSNB group (P-value 0.8). Conversely, 5-year CSS was 76% (CI 62%-92%) for bilateral ILND group and 78% (CI 63%-97%) for the ipsilateral ILND plus contralateral DSNB group (P-value 0.9). CONCLUSIONS In patients with cN1 peSCC the risk of occult contralateral nodal disease is comparable to cN0 high risk peSCC and the gold standard, namely bilateral ILND, may be replaced by unilateral ILND and contralateral DSNB without affecting positive node detection, IRRs and CSS.
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Affiliation(s)
- Sebastiano Nazzani
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Università degli Studi di Milano, Italy.
| | - Mario Catanzaro
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Davide Biasoni
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marco Maccauro
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Silvia Stagni
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Tullio Torelli
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alberto Macchi
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Valentina Bernasconi
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandra Taverna
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Dario Sessa
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alice Lorenzoni
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Luigi Piva
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Rodolfo Lanocita
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Tommaso Cascella
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Laura Cattaneo
- Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Emanuele Montanari
- Urology Department, IRCCS Policlinico Ca' Granda, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Università degli Studi di Milano, Italy
| | - Roberto Salvioni
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Nicola Nicolai
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Brassetti A, Anceschi U, Cozzi G, Chavarriaga J, Gavrilov P, Gaya Sopena JM, Bove AM, Prata F, Ferriero M, Mastroianni R, Misuraca L, Tuderti G, Torregiani G, Covotta M, Camacho D, Musi G, Varela R, Breda A, De Cobelli O, Simone G. Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement. Curr Oncol 2023; 30:1882-1892. [PMID: 36826107 PMCID: PMC9954864 DOI: 10.3390/curroncol30020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. METHODS A purpose-built multicenter, multi-national database was queried for stage I-IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan-Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. RESULTS A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score ≥ 3: 0% vs. 24%; p < 0.001). Although indicated, ILND was omitted in 8 cases (5%), while in 16, a modified template was properly used. Although median LNs yield was 17 (IQR: 11-27), 35% of the patients had <7 nodes retrieved from the groin. At Kaplan-Maier analysis, the Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94-0.99; p = 0.04). CONCLUSIONS Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-0652666772
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Cozzi
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Julian Chavarriaga
- Division of Urology, Clinica Imbanaco, Quiron Salud, Cali 760042, Colombia
- Division of Urology, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | - Pavel Gavrilov
- Department of Urology, Fondacio Puigvert, 08025 Barcelona, Spain
| | | | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Francesco Prata
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | | | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Giulia Torregiani
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Marco Covotta
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Diego Camacho
- Division of Urologic Oncology Instituto Nacional de Cancerologia, Bogota 111511, Colombia
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Rodolfo Varela
- Division of Urologic Oncology Instituto Nacional de Cancerologia, Bogota 111511, Colombia
| | - Alberto Breda
- Department of Urology, Fondacio Puigvert, 08025 Barcelona, Spain
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
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Elst L, Vreeburg M, Brouwer O, Albersen M. Challenges in Organ-sparing Surgery for Penile Cancer: What Are the Limits? Eur Urol Focus 2023; 9:241-243. [PMID: 36653257 DOI: 10.1016/j.euf.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
Organ-sparing surgery (OSS) is endorsed by the European Association of Urology (EAU) guidelines as the preferred treatment for distal primary penile cancer. The recommendation states that OSS should be used whenever possible, without exactly defining what constitutes "possible". This recommendation is based on findings showing that this approach has no detrimental impact on survival. At the same time, OSS results in preservation of quality of life (QoL) and of various functions of the penis. However, while narrow tumor-free margins (>1 mm) are deemed oncologically safe, there is a higher risk of local recurrence. Recent data have emerged that question the dogma that a local recurrence does not impact survival outcomes. In this mini review, we highlight areas of discrepancy in current guidelines and describe challenges for a surgical approach with a delicate balance between oncological safety on the one hand and maximal preservation of QoL and penile functions on the other. PATIENT SUMMARY: Organ-sparing surgery has been recommended as the preferred treatment for primary cancer of the penis, as quality of life and sexual function are maximally preserved. In this review we identify challenges and limitations in routinely adopting this approach.
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Affiliation(s)
- Laura Elst
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Manon Vreeburg
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Oscar Brouwer
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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O'Brien JS, McVey A, Kelly BD, Chee J, Lawrentschuk N. Recent developments in the diagnosis and management of N1 penile cancer. Curr Opin Urol 2023; 33:64-69. [PMID: 36444651 DOI: 10.1097/mou.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW This article presents a critical review of the current literature to provide a brief update on the contemporary advances in diagnosing and managing N1 penile cancer. RECENT FINDINGS Penile squamous cell carcinoma (pSCC) has evolved from being an orphan field for cancer innovation. Advances in the understanding tumour biology have enabled sophisticated diagnostics and predictive modelling to better characterize inguinal disease. Minimally invasive inguinal lymph node dissection is emerging as a technique that reduces morbidity while maintaining oncological safety. Furthermore, robust clinical trials are underway ,which will provide level one evidence to guide treatment decisions. Exciting advances in the field of immune-oncology offer promise as adjuvant therapies. International collaboration and centralisation of care will be essential to driving translational research and equitable evidence-based care. SUMMARY Improving outcomes for men with pSCC remains a global challenge. Radical inguinal lymph node dissection remains the gold standard for diagnosing and curing N1 disease. Although many promising developments are on the horizon, high-level evidence is required to guide therapy.
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Affiliation(s)
- Jonathan S O'Brien
- Division of Cancer Surgery, Peter MacCallum Cancer Centre
- Sir Peter MacCallum Department of Oncology, The University of Melbourne
- Department of Urology, The Royal Melbourne Hospital
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Peter MacCallum Cancer Centre
| | - Aoife McVey
- Division of Cancer Surgery, Peter MacCallum Cancer Centre
| | - Brian D Kelly
- Division of Cancer Surgery, Peter MacCallum Cancer Centre
- Sir Peter MacCallum Department of Oncology, The University of Melbourne
- Department of Urology, Eastern Health
| | - Justin Chee
- MURAC Health, East Melbourne
- Department of Urology, Alfred Health
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre
- Sir Peter MacCallum Department of Oncology, The University of Melbourne
- Department of Urology, The Royal Melbourne Hospital
- EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare, Melbourne, Victoria, Australia
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35
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Chua KJ, Balraj V, Patel HV, Srivastava A, Doppalapudi SK, Elsamra SE, Jang TL, Singer EA, Ghodoussipour SB. Wound Complication Rates after Inguinal Lymph Node Dissection: Contemporary Analysis of the NSQIP Database. J Am Coll Surg 2023; 236:18-25. [PMID: 36519902 PMCID: PMC9764259 DOI: 10.1097/xcs.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Inguinal lymph node dissection (ILND) is used for diagnosis and treatment in penile cancer (PC), vulvar cancer (VC), and melanomas draining to the inguinal lymph nodes. However, ILND is often characterized by its morbidity and high wound complication rate. Consequently, we aimed to characterize wound complication rates after ILND. STUDY DESIGN The NSQIP database was queried for ILND performed from 2005 to 2018 for melanoma, PC, or VC. Thirty-day wound complications included wound disruption and superficial, deep, and organ-space surgical site infection. Multivariable logistic regression was performed with covariates, including cancer type, age, American Society of Anesthesiologists score ≥3, BMI ≥30, smoking history, diabetes, operative time, and concomitant pelvic lymph node dissection. RESULTS A total of 1,099 patients had an ILND with 92, 115, and 892 ILNDs performed for PC, VC, and melanoma, respectively. Wound complications occurred in 161 (14.6%) patients, including 12 (13.0%), 17(14.8%), and 132 (14.8%) patients with PC, VC, and melanoma, respectively. Median length of stay was 1 day (interquartile range 0 to 3 days), and median operative time was 152 minutes (interquartile 83 to 192 minutes). Readmission rate was 12.7%. Wound complications were associated with longer operative time per 10 minutes (odds ratio 1.038, 95% CI 1.019 to 1.056, p < 0.001), BMI ≥30 (odds ratio 1.976, 95% CI 1.386 to 2.818, p < 0.001), and concomitant pelvic lymph node dissection (odds ratio 1.561, 95% CI 1.056 to 2.306, p = 0.025). CONCLUSIONS Predictors of wound complications after ILND include BMI ≥30, longer operative time, and concomitant pelvic lymph node dissection. There have been efforts to decrease ILND complication rates, including minimally invasive techniques and modified templates, which are not captured by NSQIP, and such approaches may be considered especially for those with increased complication risks.
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Affiliation(s)
- Kevin J Chua
- From the Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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36
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Zhu M, Yin H, Dong B, Yang T. Penile cancer with bilateral inguinal lymph node metastases survives more than 4 years: A case report. Asian J Surg 2022; 46:1590-1591. [PMID: 36307266 DOI: 10.1016/j.asjsur.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 12/09/2022] Open
Affiliation(s)
- Mingkai Zhu
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Huaqi Yin
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Bingqi Dong
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Tiejun Yang
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
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Oshiro H, Shimizu Y, Nakayasu R, Yamaguchi R, Uketa S, Utsunomiya N, Asai S, Katsushima H, Ishihara M, Hashimoto K, Kanamaru S. [A Case of Multiple Penile Schwannoma]. Hinyokika Kiyo 2022; 68:327-331. [PMID: 36329381 DOI: 10.14989/actauroljap_68_10_327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A 48-year-old man presented with a painless nodule on the right ventral aspect of the penile shaft root. The patient visited the hospital and complained that the mass was growing. On physical examinations, a 5 cm mass without tenderness was palpated. An isoechoic mass about 4 cm in size was observed on ultrasonography. Inhomogeneous high signal intensity was observed on T2-weighted magnetic resonance imaging. A needle biopsy revealed schwannoma. During surgery for excision of the tumor, another small tumor was detected both tumors were resected. Both tumors were diagnosed as schwannoma by pathological examination. Out of 40 cases of penile schwannoma reported, eight were of multiple tumors. In our case, it was difficult to detect the other small tumor by preoperative diagnosis. Therefore, we recommend careful observation during surgery.
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Affiliation(s)
- Hiroki Oshiro
- The Department of Urology, Kobe City Nishi-Kobe Medical Center
| | - Yousuke Shimizu
- The Department of Urology, Kobe City Nishi-Kobe Medical Center
| | - Ryota Nakayasu
- The Department of Urology, Kobe City Nishi-Kobe Medical Center
| | | | - Shoko Uketa
- The Department of Urology, Kobe City Nishi-Kobe Medical Center; The Department of Urology, Otsu Municipal Hospital
| | | | - Satsuki Asai
- The Department of Pathology, Kobe City Nishi-Kobe Medical Center
| | | | - Misa Ishihara
- The Department of Pathology, Kobe City Nishi-Kobe Medical Center
| | - Kimio Hashimoto
- The Department of Pathology, Kobe City Nishi-Kobe Medical Center
| | - Sojun Kanamaru
- The Department of Urology, Kobe City Nishi-Kobe Medical Center
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38
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Whyte E, Sutcliffe A, Keegan P, Clifford T, Matu J, Shannon OM, Griffiths A. Effects of partial penectomy for penile cancer on sexual function: A systematic review. PLoS One 2022; 17:e0274914. [PMID: 36137121 PMCID: PMC9499284 DOI: 10.1371/journal.pone.0274914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Penile cancer is a rare but debilitating condition, which often requires aggressive treatment. Partial penectomy is considered as a treatment option when a sufficient portion of the penile shaft can be maintained to preserve functionality. This systematic review, which followed the PRIMSA guidelines, aimed to evaluate the effects of partial penectomy for penile cancer on sexual function—the maintenance of which is often a priority in patient groups—and to identify potential factors which may moderate these effects. A systematic search of PubMed, The Cochrane Library, and Open Grey as well as MEDLINE, CINAHL and Open Dissertations via EBSCOhost was conducted from inception through to 24th March, 2022. Studies were required to include adults aged ≥18 years who had undergone partial penectomy for the treatment of penile cancer, with a quantitative measure of sexual function available pre- and post-surgery. Four eligible articles were identified for inclusion in this review, three of which reported a decrease in sexual function pre- to post-surgery across all domains of the International Index of Erectile Function (IIEF) questionnaire (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction). Conversely, one study reported an increase in sexual function across IIEF domains, except for orgasmic function, which decreased, pre- to post-surgery. Greater penile length was associated with higher post-operative sexual function, whilst increasing age and higher anxiety levels were associated with lower post-operative sexual function levels in one study. Despite the overall drop in sexual function, many patients were still able to maintain satisfactory sex lives following partial penectomy. Given the limited research in this area and small sample sizes across studies, additional well-controlled investigations are warranted to provide further evidence on the effects of partial penectomy for penile cancer on sexual function.
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Affiliation(s)
- Eleanor Whyte
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Alexandra Sutcliffe
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Philip Keegan
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Tom Clifford
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, United Kingdom
| | - Jamie Matu
- School of Health, Leeds Beckett University, Leeds, United Kingdom
| | - Oliver M. Shannon
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Alex Griffiths
- School of Health, Leeds Beckett University, Leeds, United Kingdom
- * E-mail:
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Pang KH, Muneer A, Alnajjar HM. Glansectomy and Reconstruction for Penile Cancer: A Systematic Review. Eur Urol Focus 2022; 8:1318-1322. [PMID: 34903488 DOI: 10.1016/j.euf.2021.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/24/2021] [Accepted: 11/26/2021] [Indexed: 12/16/2022]
Abstract
Penile cancer (PeCa) is a rare disease, with a global incidence of 36068 new cases reported in the 2020 GLOBOCAN database. Narrower excision margins are now acceptable without compromising survival. Glansectomy is commonly performed for invasive PeCa confined to the glans penis. The majority of data on glansectomy are from small single-centre series. We provide a contemporary update on the outcomes of glansectomy via a systematic review of glansectomy for PeCa. Overall, 20 studies were included in the analysis. The local recurrence rate was 2.6-16.7%. The incidence of salvage penectomy for positive margins and/or recurrence was 1.2-8.3%. The disease-specific survival rate was 89-96.6%. A split-thickness skin graft was commonly used to reconstruct a neoglans and the graft loss rate was 1.5-23.5%. The incidence of meatal stenosis was 2.8-14.3%. Good cosmetic outcomes and normal erections were reported in 95-100% and 50-100% of cases, respectively. Glansectomy provides acceptable oncological control without significantly compromising functional outcomes. PATIENT SUMMARY: Penile cancer invading into the head of the penis can be surgically treated with a procedure called glansectomy that has good cancer control and cosmetic outcomes. In addition, penile length can be preserved, which allows men to urinate standing up and to achieve penetrative sexual intercourse.
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Affiliation(s)
- Karl H Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Section of Andrology, Pyrah Department of Urology, St James' Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Asif Muneer
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; UCL Male Genital Cancer Centre, Division of Surgery and Interventional Science, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospital, London, UK
| | - Hussain M Alnajjar
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.
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40
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Belbina SH, Gereta S, Schmolze MR, Bradford JM, Yang C, Laviana AA. A Rare Case of Penile Mucosal Melanoma. Urology 2022; 169:e13-e15. [PMID: 35926663 DOI: 10.1016/j.urology.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 11/20/2022]
Affiliation(s)
| | - Sofia Gereta
- Dell Medical School at the University of Texas, Austin, TX
| | - Mia Rose Schmolze
- The University of Texas Rio Grande Valley School of Medicine, Edinburg, TX
| | | | | | - Aaron A Laviana
- Dell Medical School at the University of Texas, Austin, TX; Department of Surgery and Perioperative Care, University of Texas at Austin Dell Seton Medical Center, Austin, TX.
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41
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Subirá-Ríos D, Caño-Velasco J, Moncada-Iribarren I, González-García J, Polanco-Pujol L, Subirá-Rios J, Hernández-Fernández C. Pelvic and inguinal single-site approach: PISA technique. New minimally invasive technique for lymph node dissection in penile cancer. Actas Urol Esp 2022; 46:150-158. [PMID: 35272966 DOI: 10.1016/j.acuroe.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To describe our initial experience with a new minimally invasive inguinal and pelvic single-access laparoscopic approach, for performing lymph node dissection (LND) in penile cancer: the Pelvic and Inguinal Single Access (PISA) technique. MATERIAL AND METHODS 10 patients with different penile squamous cell carcinoma stages (cN0 and ≥pT1G3 or cN1/cN2) were operated by means of the PISA technique, between 2015-2018. Intraoperative frozen section analysis was carried out routinely and if ≥2 inguinal nodes (pN2) or extracapsular nodal extension (pN3) are detected, ipsilateral pelvic LND was performed sequentially as a single-stage procedure and using the same surgical incisions. VARIABLES 30-day PCs, estimated blood loss (EBL), transfusion rate, operative time, time to drainage removal, and length of hospital stay (LOS). Medians and ranges of values for selected variables were reported as descriptive statistics. RESULTS Inguinal LND was bilateral in all cases, and pelvic LND was required in 40%. Total operative time was 120-170 min and median EBL was 66 (30-100) cc. No blood transfusion was required. No intraoperative complications were noted, and postoperative complications rate was 40% (10% major complications-symptomatic inguinal lymphocele). Median LOS was 5.8 (3-10) days. Median time to inguinal drain removal was 4.7 days. Mean number of lymph nodes removed by inguinal LND: 10.25 (8-14). Limited volume retrospective experience from a referral center with short follow-up. Outcomes reported may not be reproducible by surgeons with less experience and skills. CONCLUSIONS PISA is a novel, minimally invasive single-site surgical approach to one stage bilateral inguinal/pelvic LNDs for penile cancer showing a low rate of major complications.
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Affiliation(s)
- D Subirá-Ríos
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Servicio de Urología, Hospital Universitario La Zarzuela, Madrid, Spain.
| | - J Caño-Velasco
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - J González-García
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - L Polanco-Pujol
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Subirá-Rios
- Servicio de Urología, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - C Hernández-Fernández
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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42
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Wada T, Masanobu E, Watanabe M, Kasahara K, Masaki J, Ishizaki T, Narahashi K, Yoriki R, Saito H, Nagakawa Y, Katsumata K, Tsuchida A. [A Case of Laparoscopic Ileus Release for Intestinal Obstruction Due to Small Intestinal Metastasis Four Years after Penile Cancer Surgery]. Gan To Kagaku Ryoho 2022; 49:330-332. [PMID: 35299196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We report a rare case of metastatic small intestine cancer originating from penile cancer triggered by intestinal obstruction, with some review of the literature. The case was a 78-year-old man at the first visit. Partial penile resection was performed for penile cancer. Histopathological findings were squamous cell carcinoma, and the surgical margin was negative. The stage at the time of the first surgery was T2N0M0, Stage Ⅱ. He came to the hospital with a complaint of abdominal pain 4 years after the operation. He was diagnosed with intestinal obstruction and was treated medically. He underwent medical treatment for 12 days, but did not improve, so he underwent laparoscopic ileus release. Surgical findings showed a neoplastic lesion in the abdominal cavity, and the site was obstructed, and partial resection of the small intestine including the neoplastic lesion was performed. Pathological examination revealed small intestinal metastasis of penile cancer. Postoperative intestinal obstruction improved and he was discharged without complications. After discharge, he underwent systemic chemotherapy at an outpatient clinic, but died of the primary disease 181 days after intestinal obstruction.
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Affiliation(s)
- Takahiro Wada
- Dept. of Gastroenterology and Pediatric Surgery, Tokyo Medical University
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43
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Nekula M, Dušek P, Babjuk M. Penile amputation for sarcoma. Rozhl Chir 2022; 101:134-137. [PMID: 35387470 DOI: 10.33699/pis.2022.101.3.134-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Penile cancer is uncommon among other urological malignancies, squamous cell carcinoma being the most common type of penile cancer. This case report presents a patient with rapidly progressive angiosarcoma who underwent penile amputation.
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44
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Adanu KK, Toboh B, Akpakli E, Monney M, Asiedu I, Nyinah M, Wereh B, Amoah Y, Kyei M, Mensah JE. Penile carcinoma: a report of two cases treated by partial penectomy, its effects on quality of life and review of literature: a case report. Pan Afr Med J 2022; 41:33. [PMID: 35382045 PMCID: PMC8956897 DOI: 10.11604/pamj.2022.41.33.29970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 01/05/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kekeli Kodjo Adanu
- Department of Urology, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Surgery, University of Health and Allied Sciences, Ho, Ghana
- Corresponding author: Kekeli Kodjo Adanu, Department of Urology, Korle Bu Teaching Hospital, Accra, Ghana.
| | - Bernard Toboh
- Department of Urology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Evans Akpakli
- Department of Urology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Mary Monney
- Department of Urology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Isaac Asiedu
- Department of Urology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Maxwell Nyinah
- Department of Urology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Bright Wereh
- Department of Urology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Yaw Amoah
- Department of Urology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Matthew Kyei
- Department of Urology, Korle Bu Teaching Hospital, Accra, Ghana
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Groeben C, Koch R, Kraywinkel K, Buttmann-Schweiger N, Baunacke M, Borkowetz A, Thomas C, Huber J. Development of Incidence and Surgical Treatment of Penile Cancer in Germany from 2006 to 2016: Potential Implications for Future Management. Ann Surg Oncol 2021; 28:9190-9198. [PMID: 34120266 PMCID: PMC8591000 DOI: 10.1245/s10434-021-10189-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/21/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Penile cancer is a rare disease and surgical treatment often entails a significant impact on quality of life. The aim of this study was to analyze trends in surgical treatment patterns in Germany. METHODS We analyzed data from the nationwide German hospital billing database and the German cancer registry from 2006 to 2016. All penile cancer cases with penile surgery or lymph node dissection (LND) were included. We also analyzed the distribution of cases, extent of surgery, and length of hospital stay, stratified for annual caseload. The geographical distribution of centers for 2016 was presented. RESULTS During the investigated timespan, tumor incidences increased from 748 to 971 (p = 0.001). We identified 11,353 penile surgery cases, increasing from 886 to 1196 (p < 0.001), and 5173 cases of LND, increasing from 332 to 590 (p < 0.001). Cases of partial amputation increased from 45.8 to 53.8% (p < 0.001), while total amputation remained stable at 11.2%. Caseload in high-volume hospitals increased from 9.0 to 18.8% for penile surgery (p < 0.001) and from 0 to 13.1% for LND (p < 0.001). The increase in LND caseload was caused by an increase in inguinal LND, from 297 to 505 (p < 0.001), with increasing sentinel LND, from 14.2 to 21.9% (p = 0.098). The assessment of geographical distribution of cases in Germany revealed extensive areas without sufficient coverage by experienced centers. CONCLUSIONS We saw consistent increases in penile surgery and LND, with a growing number of cases in high-volume hospitals, and, accordingly, an increase in tumor incidence. The increasing use of inguinal LND and organ-preserving surgery reflect the adaptation of current guidelines; however, geographical distribution of experienced centers could be improved.
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Affiliation(s)
- Christer Groeben
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
| | - Rainer Koch
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Klaus Kraywinkel
- National Center for Cancer Registry Data, Robert Koch Institute, Berlin, Germany
| | | | - Martin Baunacke
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Johannes Huber
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Azevedo RA, Roxo AC, Alvares SHB, Baptista DP, Favorito LA. Use of flaps in inguinal lymphadenectomy in metastatic penile cancer. Int Braz J Urol 2021; 47:1108-1119. [PMID: 34115457 PMCID: PMC8486440 DOI: 10.1590/s1677-5538.ibju.2021.99.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/20/2021] [Indexed: 04/04/2024] Open
Abstract
PURPOSE Reviewing surgical procedures using fasciocutaneous and myocutaneous flaps for inguinal reconstruction after lymphadenectomy in metastatic penile cancer. MATERIAL AND METHODS We reviewed the current literature of the Pubmed database according to PRISMA guidelines. The search terms used were "advanced penile cancer", "groin reconstruction", and "inguinal reconstruction", both alone and in combination. The bibliographic references used in the selected articles were also analyzed to include recent articles into our research. RESULTS A total of 54 studies were included in this review. About one third of penile cancers are diagnosed with locally advanced disease, often presenting with large lymph node involvement. Defects in the inguinal region resulting from the treatment of metastatic penile cancer are challenging for the surgeon and cause high patient morbidity, rendering primary closure unfeasible. Several fasciocutaneous and myocutaneous flaps of the abdomen and thigh can be used for the reconstruction of the inguinal region, transferring tissue to the affected area, and enabling tensionless closure. CONCLUSIONS The reconstruction of defects in the inguinal region with the aid of flaps allows for faster postoperative recovery and reduces the risk of complications. Thus, the patient will be able to undergo potential necessary adjuvant treatments sooner.
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Affiliation(s)
- Roberta Alvares Azevedo
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
- Universidade do Estado do Rio de JaneiroDepartamento de Cirurgia GeralRio de JaneiroRJBrasilDepartamento de Cirurgia Geral, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
| | - Ana Claudia Roxo
- Universidade do Estado do Rio de JaneiroDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Departamento de Cirurgia Geral, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
| | - Silvia Helena Baima Alvares
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
| | - Daniel Pereira Baptista
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
| | - Luciano A. Favorito
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
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47
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Ghosh P, Chandra A, Mukhopadhyay S, Chatterjee A, Lingegowda D, Gehani A, Gupta B, Gupta S, Midha D, Sen S. Accuracy of MRI without intracavernosal prostaglandin E1 injection in staging, preoperative evaluation, and operative planning of penile cancer. Abdom Radiol (NY) 2021; 46:4984-4994. [PMID: 34189611 DOI: 10.1007/s00261-021-03194-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the performance of non-erectile MRI in staging and preoperative evaluation of penile carcinomas, compared to postoperative histopathology. METHODS In this retrospective study, MRI scans of patients who had undergone surgery for penile carcinoma (n = 54) between January 2012 and April 2018 were read by two radiologists; and disagreement was solved in the presence of a third experienced radiologist. Data necessary for preoperative evaluation and staging were collected and compared with final postoperative histology and the type of surgery performed. All MRI had been performed without intracavernosal injection of prostaglandin E1 and with IV Gadolinium, as per local protocol. RESULTS 54 patients were included in the study (mean age 57.52 ± 12.78). The number of patients with T1, T2, and T3 staging in histopathology were 32, 14, and 8. Moderate interobserver agreement was found for staging, disease-free penile length, and all subsites except urethra, which had weak agreement. Strong agreement of consensus MRI with final histopathological staging was found (49/54, weighted κ = 0.85), with high sensitivity and specificity. Sensitivity and specificity for involvement of corpus spongiosum, corpora cavernosa, and urethra were 95.5% and 93.8%, 87.5% and 97.8%, and 90.9% and 86.1%, respectively. Sensitivity (89.6%) and specificity (100%) of MRI for predicting adequate disease-free penile length were high. CONCLUSION There were acceptable interobserver agreement and good diagnostic performance of MRI for staging and preoperative assessment without intracavernosal injection, especially for higher stages and higher degrees of invasion which require more extensive surgery.
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Affiliation(s)
- Priya Ghosh
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India.
| | - Aditi Chandra
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Sumit Mukhopadhyay
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Argha Chatterjee
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Dayananda Lingegowda
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Anisha Gehani
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Bharat Gupta
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Sujoy Gupta
- Department of Urological Oncology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, Kolkata, West Bengal, 700160, India
| | - Divya Midha
- Department of Pathology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, Kolkata, West Bengal, 700160, India
| | - Saugata Sen
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
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Zekan DS, Dahman A, Hajiran AJ, Luchey AM, Chahoud J, Spiess PE. Prognostic predictors of lymph node metastasis in penile cancer: a systematic review. Int Braz J Urol 2021; 47:943-956. [PMID: 33650835 PMCID: PMC8321459 DOI: 10.1590/s1677-5538.ibju.2020.0959] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Squamous cell carcinoma (SCC) of the penis is a rare disease in developed countries but is associated with significant morbidity and mortality. A crucial prognostic factor is the presence of inguinal lymph node metastases (ILNM) at the time of diagnosis. At least 25% of cases have micrometastases at the time of diagnosis. Therefore, we performed a literature review of studies evaluating factors, both clinical and pathological, predictive of lymph node metastases in penile SCC. MATERIALS AND METHODS Studies were identified using PubMed and search terms included the following: penile cancer, penile tumor, penile neoplasm, penile squamous cell carcinoma, inguinal lymph node metastasis, lymph node metastases, nodal metastasis, inguinal node metastasis, inguinal lymph node involvement, predictors, and predictive factor. The number of patients and predictive factors were identified for each study based on OR, HR, or RR in multivariate analyses, as well as their respective significance values. These were compiled to generate a single body of evidence supportive of factors predictive of ILNM in penile SCC. RESULTS We identified 31 studies, both original articles and meta-analyses, which identified factors predictive of metastases in penile SCC. The following clinical factors were predictive of ILNM in penile SCC: lymphovascular invasion (LVI), increased grade, increased stage (both clinical and pathological), infiltrative and reticular invasion, increased depth of invasion, perineural invasion, and younger patient age at diagnosis. Biochemically, overexpression of p53, SOD2, Ki-67, and ID1 were associated with spread of SCC to inguinal lymph nodes. Diffuse PD-L1 expression, increased SCC-Ag expression, increased NLR, and CRP >20 were also associated with increased ILNM. CONCLUSIONS A multitude of factors are associated with metastasis of SCC of the penis to inguinal lymph nodes, which is associated with poor clinical outcomes. The above factors, most strongly LVI, grade, and node positivity, may be considered when constructing a nomogram to risk-stratify patients and determine eligibility for prophylactic inguinal lymphadenectomy.
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Affiliation(s)
- David S. Zekan
- West Virginia UniversityDepartment of UrologyMorgantownWVUSADepartment of Urology, West Virginia University, Morgantown, WV, USA.
| | - Ahmad Dahman
- West Virginia UniversityDepartment of UrologyMorgantownWVUSADepartment of Urology, West Virginia University, Morgantown, WV, USA.
| | - Ali J. Hajiran
- H. Lee Moffitt Cancer Center & Research InstituteDepartment of Genitourinary OncologyTampaFLUSADepartment of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
| | - Adam M. Luchey
- West Virginia UniversityDepartment of UrologyMorgantownWVUSADepartment of Urology, West Virginia University, Morgantown, WV, USA.
| | - Jad Chahoud
- H. Lee Moffitt Cancer Center & Research InstituteDepartment of Genitourinary OncologyTampaFLUSADepartment of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
| | - Philippe E. Spiess
- H. Lee Moffitt Cancer Center & Research InstituteDepartment of Genitourinary OncologyTampaFLUSADepartment of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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Chavarriaga J, Pardo J, Suso-Palau D, Becerra L, Camacho D, Godoy F, Forero J, Cabrera M, López-de-Mesa B, Ramirez A, Varela R. Real World Data of Penile Cancer Treatment at a High-Volume Center in South America: Insights and Survival Trends. Urology 2021; 156:199-204. [PMID: 34310915 DOI: 10.1016/j.urology.2021.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/28/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report survival trends and oncological outcomes of penile cancer surgically treated patients, at a high-volume center, treating more than 25 patients each year, in a high incidence country. METHODS Clinical charts of all patients that underwent surgical management for penile cancer were reviewed. The primary end points were cancer specific survival (CSS), progression-free survival, and local recurrence free survival. Kaplan-Meier plots were used for survival analyses. Multivariate analysis was performed using cox proportional hazard age-adjusted models to determine the effect of pN, pT, lymphovascular invasion for CSS. RESULTS A total of 209 patients were identified, with a median follow up of 96 months (IQR 49-133). Organ-sparing surgerywas performed in 72.7%, 56.9% underwent dynamic sentinel lymph node biopsy, 110 patients underwent inguinal lymph node dissection, and 45 (21.5%) pelvic lymph node dissection. A total of 75 (35.8%) of patients relapsed, median time to relapse of 12 months (IQR 6-25). Overall estimates of CSS showed an 8-year CSS of 68.9%. Eight-year CSS was 90.5% for N0, and 32.8% in pN3 (P <.001). The Cox proportional hazard model showed that pN1-3, pT2-4, lymphovascular invasion and positive dynamic sentinel lymph node biopsy were the variables associated with worse 8-year CSS. CONCLUSION To the best of our knowledge, we report one of the largest cohorts on the survival outcomes of penile cancer surgical treatment, in a single institution, over a long period of time, were most patients are referred with high-risk, locally advanced or nodal disease.
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Affiliation(s)
- Julián Chavarriaga
- Department of Urologic Oncology, Instituto Nacional de Cancerología. Bogotá, Colombia; Division of Urology, Clínica Imbanaco, Grupo Quirón Salud. Cali, Colombia; Division of Urology, Pontificia Universidad Javeriana. Bogotá, Colombia.
| | - Julián Pardo
- Department of Urologic Oncology, Instituto Nacional de Cancerología. Bogotá, Colombia
| | - Daniel Suso-Palau
- Division of Urology, Clínica Imbanaco, Grupo Quirón Salud. Cali, Colombia
| | - Luis Becerra
- Department of Urologic Oncology, Instituto Nacional de Cancerología. Bogotá, Colombia
| | - Diego Camacho
- Department of Urologic Oncology, Instituto Nacional de Cancerología. Bogotá, Colombia
| | - Fabián Godoy
- Department of Urologic Oncology, Instituto Nacional de Cancerología. Bogotá, Colombia
| | - Jorge Forero
- Department of Urologic Oncology, Instituto Nacional de Cancerología. Bogotá, Colombia
| | - Marino Cabrera
- Department of Urologic Oncology, Instituto Nacional de Cancerología. Bogotá, Colombia
| | - Byron López-de-Mesa
- Department of Urologic Oncology, Instituto Nacional de Cancerología. Bogotá, Colombia
| | - Angie Ramirez
- Department of Urologic Oncology, Instituto Nacional de Cancerología. Bogotá, Colombia
| | - Rodolfo Varela
- Department of Urologic Oncology, Instituto Nacional de Cancerología. Bogotá, Colombia
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Patel AS, Isharwal S. Single-port robotic inguinal lymph node dissection: A safe and feasible option for penile cancer. Surg Oncol 2021; 38:101633. [PMID: 34332496 DOI: 10.1016/j.suronc.2021.101633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/21/2021] [Accepted: 07/11/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Inguinal lymph node dissection (ILND) is essential to the accurate staging of advanced penile cancer and in determining prognosis. Open ILND is associated with significant morbidity. The robotic-assisted approach has been described with comparable nodal yield with the advantage of decreased postoperative complications when studied with the multiport robotic platform. This video shows our approach for an ILND with the Intuitive single port (SP) robotic platform. METHOD A 54-year-old man underwent a partial penectomy for a penile mass that revealed squamous cell carcinoma invading the corpus spongiosum (pT2). Patient had non-palpable lymph nodes on physical examination. We proceeded with the bilateral inguinal lymph node dissection using the Intuitive da Vinci Single-Port Robot. RESULTS A standard template dissection was performed on both sides. Due to nodal enlargement noted on the pre-operative CT scan on the right side, superficial and deep ILND were performed on that side. Intra-operative frozen section pathologies of superficial lymph nodes were negative on the left side. Bilateral saphenous veins were preserved. Total procedure time was 4 hours and 51 minutes in duration with minimal blood loss noted (<30 mL). Pathology revealed one 4.5cm superficial positive node on the right with no extra-nodal extension and no other positive nodes. No complications were noted. He was discharged on post-operative day 1 with minimal pain or leg swelling. CONCLUSIONS We describe the technique and feasibility of ILND using the SP robotic platform. This approach has the potential to reduce morbidity with comparable nodal dissection as the open approach.
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Affiliation(s)
- Amir S Patel
- Department of Urology, Oregon Health and Science University, Portland, OR, USA.
| | - Sudhir Isharwal
- Department of Urology, Oregon Health and Science University, Portland, OR, USA
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