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Manurung MA, Umbas R, Hamid ARAH, Mochtar CA. Penile carcinoma: A retrospective analysis of 93 patients at a tertiary care center in Jakarta, Indonesia. Int J Urol 2024. [PMID: 38641982 DOI: 10.1111/iju.15462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/31/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES Penile carcinoma (PC) is a rare disease with considerable physical and psychological impact. To date, there is no data regarding PC prevalence and characteristics in Indonesia. This study aimed to analyze the characteristics of patients with PC in Indonesia and determine cumulative survival rates and time to disease progression. METHODS This was a retrospective study of all patients diagnosed with PC at Cipto Mangunkusumo General Hospital from 1995 to 2014, with a minimum of 1 year follow-up. The outcomes of the study were cumulative survival rates and time-to-disease progression. RESULTS Ninety-three subjects were recruited, with a mean age of 49.44 ± 13.62. Inguinal lymph node dissection (ILND) was performed in 49 (53%) patients. The mean survival in the ILND group was better compared to the non-ILND group (80.7 months vs. 67.1 months; p = 0.032). Time-to-progression in the ILND group was significantly longer than in the non-ILND group (71.7 months vs. 54.3 months; p = 0.022). No significant difference in survival between the total and partial penectomy (PP) groups was observed (p = 0.701). Time-to-progression in total penectomy (TP) was significantly longer than in PP (68 months vs. 56.0 months; p = 0.023). In Cox-regression analysis, after adjustment of other variables, history of ILND, higher stage of cancer, and older age were found to affect the survival of patients. CONCLUSION ILND in PC led to better survival and reduced disease progression. The type of penectomy is only associated with progression but not survival. TP had a longer time to disease progression compared to PP.
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Affiliation(s)
- Mega Anara Manurung
- Department of Urology, Faculty of Medicine/Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Rainy Umbas
- Department of Urology, Faculty of Medicine/Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Agus Rizal A H Hamid
- Department of Urology, Faculty of Medicine/Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Chaidir Arif Mochtar
- Department of Urology, Faculty of Medicine/Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Prognostic Significance of Systemic Inflammation Markers in Testicular and Penile Cancer: A Narrative Review of Current Literature. Life (Basel) 2023; 13:life13030600. [PMID: 36983756 PMCID: PMC10054741 DOI: 10.3390/life13030600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
In contemporary clinical practice, biomarkers are indispensable in the assessment and management of oncological patients. Although established serum tumor markers (beta human chorionic gonadotropin (bHCG), alpha fetoprotein (AFP), and lactate dehydrogenase (LDH)) have an indisputably important role in the management of patients with testicular cancer (TC), the application of these tumor markers may be accompanied with certain limitations, implying the need for additional biomarkers. Contrary to TC, there is a lack of established serological biomarkers for penile cancer (PC) and the management of this urological malignancy is based on multiple clinicopathological parameters. Therefore, the identification and rigorous analytical and clinical validation of reliable biomarkers are considered pivotal for improving PC management. Inflammation may be associated with all stages of oncogenesis, from initial neoplastic transformation to angiogenesis, tissue invasion, and metastasis. Accordingly, an array of inflammation-related indices have gained increasing attention as emerging predictors of oncological outcomes. The clinical usefulness of systemic inflammation markers was reported in many urological and non-urological malignancies. The aim of this narrative review is to summarize current scientific data regarding the prognostic and predictive significance of systemic inflammation markers in TC and PC patients.
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Saputra HM, Hidayatullah F, Kloping YP, Renaldo J, Chung E, Hakim L. Prognostic value of neutrophil-to-lymphocyte ratio (NLR) in penile cancer: A systematic review and meta-analysis. Ann Med Surg (Lond) 2022; 81:104335. [PMID: 36147188 PMCID: PMC9486611 DOI: 10.1016/j.amsu.2022.104335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background Penile cancer is rare among male malignancies. Various biomarkers have been used to predict the prognosis of cancer, one of which is the neutrophil to lymphocyte ratio (NLR). Therefore, we conducted this systematic review and meta-analysis to evaluate the prognostic value of NLR in penile cancer. Methods This review was conducted following the PRISMA guideline. Several databases, including Scopus, Science-direct, and PubMed, were systematically searched. The primary outcomes were lymph node metastasis (LNM), cancer-specific survival (CSS), and overall survival (OS). All statistical analyses were processed using Review Manager (RevMan) version 5.4. Results A total of six retrospective studies were included in the analysis. The cut-off values of NLR in the included studies ranged from 2.6 to 3.59. Meta-analysis showed that penile cancer patients with high NLR had worse LNM and CSS based on the univariate analysis (OR 3.56, 95% CI 2.38, 5.32, p < 0.01; HR 4.19, 95% CI 2.19, 8.01, p = 0.0; respectively). Furthermore, the meta-analysis revealed that NLR is an independent predictor of LNM and CSS (OR 6.67, 95% CI 2.44, 18.22, p < 0.01; HR 2.15, 95% CI 1.23, 3.73, p < 0.01; respectively). However, NLR failed to show as independent predictor for OS (HR 1.69,95% CI 0.95,3.00, p = 0.07). Conclusion NLR is an independent predictor of LNM and CSS. However, NLR is not proven to be an independent predictor of OS in this study. NLR is an independent predictor of LNM in penile cancer. NLR is an independent predictor of CSS in penile cancer. This study failed to demonstrate the association of NLR as predictor for OS.
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Jindal T, Pawar P, Agarwal S, Jain P, Meena M, Sarwal A, Dhanalakshmi M. The use of preoperative neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio in predicting survival and groin node involvement of patients with squamous cell carcinoma of penis. Urol Ann 2021; 13:391-396. [PMID: 34759652 PMCID: PMC8525483 DOI: 10.4103/ua.ua_112_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/11/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: The association between inflammation and malignancies is being recognized. In this study, we assessed the use of preoperative neutrophil–lymphocyte ratio (NLR) and lymphocyte–monocyte ratio (LMR) in predicting cancer-specific survival (CSS) and inguinal node involvement in patients with carcinoma penis. Methods: Sixty-nine patients operated for squamous cell carcinoma penis with inguinal node dissection between 2012 and 2020 were identified. We recorded the type of surgery (partial/total penectomy), T stage, grade, lymphovascular invasion (LVI), perineural invasion (PNI), pathological status of inguinal nodes and nodal stage (pN1–3), extranodal extension (ENE), and CSS. The hemogram performed within 2 weeks of surgery was used for calculating NLR and LMR. Results: Partial penectomy was the most common surgery (65.22%) and pT2 was the most common stage (53.62%). Grade 2 was seen in 66.67%, LVI in 34.78%, PNI in 37.68%, 52.17% had inguinal node involvement with pN3 being the most common (36.23%), and 36.23% had ENE. Kaplan–Meier analysis revealed that NLR of >3 and the LMR ≤3 indicated an inferior CSS (P = 0.05 and 0.04, respectively). T stage, inguinal node involvement, LVI, pN stage, and ENE were also associated with inferior CSS (P < 0.05). On multivariate analysis, T stage was significantly associated with CSS (P = 0.02). The NLR >3 and LMR ≤3 were also significantly associated with the presence of pathological inguinal node involvement (P = 0.001 and 0.026). Conclusion: NLR and LMR may help in predicting CSS and inguinal node involvement in patients of carcinoma penis.
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Affiliation(s)
- Tarun Jindal
- Department of Uro-oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Pravin Pawar
- Department of Uro-oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Sanjit Agarwal
- Department of Breast Surgery, Tata Medical Centre, Kolkata, West Bengal, India
| | - Prateek Jain
- Department of Head and Neck Surgery, Tata Medical Centre, Kolkata, West Bengal, India
| | - Monika Meena
- Department of Obstetrics and Gynecology, ILS Hospital, Kolkata, West Bengal, India
| | - Ankush Sarwal
- Department of Uro-oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - M Dhanalakshmi
- Department of Uro-oncology, Tata Medical Centre, Kolkata, West Bengal, India
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Draeger DL, Groh S, Buchholz T, Woehl M, Nolting J, Hakenberg OW. Prediction of Treatment Response and Survival with Chemotherapy for Metastatic Penile Cancer by the Modified Glasgow Prognostic Score. Urol Int 2021; 107:489-495. [PMID: 34610603 DOI: 10.1159/000519358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE There is increasing evidence that a persistent systemic inflammatory response predicts lower survival in patients with malignant disease. The modified Glasgow Prognostic Score (mGPS) is defined by a combination of elevated C-reactive protein (CRP) (>10 mg/L) and hypoalbuminemia (<35 g/L). It is considered as an independent prognostic marker in several organ malignancies. The aim of this study was to investigate the value of mGPS in metastatic penile carcinoma in predicting treatment response and survival. METHODS One hundred and fifty-six patients with penile carcinoma treated with chemotherapy were included in this retrospective study. The mGPS before chemotherapy was classified into 3 groups (mGPS 0 [CRP <10, any albumin], mGPS 1 [CRP >10 mg/L, albumin >35 g/L], and mGPS 2 [CRP >10 mg/L, albumin <35 g/L]). Overall survival and disease-free survival were calculated by Kaplan-Meier analysis and chemotherapy toxicity by CTC criteria. Univariate Cox proportional hazards models were calculated to estimate the effect of each predictor on OS and DFS. RESULTS Survival was significantly different in the 3 mGPS classes, with mGPS 0 patients showing the best treatment response and survival. Univariate analysis showed that mGPS (p < 0.0001), tumor stage (p = 0.004), and venous and lymphatic invasion (p = 0.011) were factors independently associated with prognosis. The response to chemotherapy differed significantly between mGPS groups (mGPS 0, 36/51 [71%]; mGPS 1, 24/70 [34%]; mGPS 2, 9/35 [26%], p = 0.03 and p = 0.37, respectively). mGPS was significantly associated with chemotherapy-associated toxicity, with treatment adaptation (p < 0.01) and toxicity-related deaths (p = 0.028). CONCLUSIONS Systemic inflammatory response and nutritional status as expressed by the mGPS are independent predictors of treatment response, chemotherapy-associated toxicity, and survival in metastatic penile carcinoma. In addition to other known pathological markers of tumor aggressiveness, the mGPS can be used as a clinical predictor of prognosis.
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Affiliation(s)
| | - Sophie Groh
- Department of Urology, Medical University of Rostock, Rostock, Germany
| | - Tim Buchholz
- Department of Urology, Medical University of Rostock, Rostock, Germany
| | - Maria Woehl
- Department of Urology, Medical University of Rostock, Rostock, Germany
| | - Julia Nolting
- Department of Urology, Medical University of Rostock, Rostock, Germany
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Li P, Wu W, Zhang T, Wang Z, Li J, Zhu M, Liang Y, You W, Li K, Ding R, Huang B, Wu L, Duan W, Han Y, Li X, Tang X, Wang X, Shen H, Wang Q, Yan H, Xia X, Ji Y, Chen H. Implications of cardiac markers in risk-stratification and management for COVID-19 patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:158. [PMID: 33902676 PMCID: PMC8074282 DOI: 10.1186/s13054-021-03555-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/30/2021] [Indexed: 01/08/2023]
Abstract
Background COVID-19 has resulted in high mortality worldwide. Information regarding cardiac markers for precise risk-stratification is limited. We aim to discover sensitive and reliable early-warning biomarkers for optimizing management and improving the prognosis of COVID-19 patients. Methods A total of 2954 consecutive COVID-19 patients who were receiving treatment from the Wuhan Huoshenshan Hospital in China from February 4 to April 10 were included in this retrospective cohort. Serum levels of cardiac markers were collected after admission. Coronary artery disease diagnosis and survival status were recorded. Single-cell RNA-sequencing and bulk RNA-sequencing from different cohorts of non-COVID-19 were performed to analyze SARS-CoV-2 receptor expression. Results Among 2954 COVID-19 patients in the analysis, the median age was 60 years (50–68 years), 1461 (49.5%) were female, and 1515 (51.3%) were severe/critical. Compared to mild/moderate (1439, 48.7%) patients, severe/critical patients showed significantly higher levels of cardiac markers within the first week after admission. In severe/critical COVID-19 patients, those with abnormal serum levels of BNP (42 [24.6%] vs 7 [1.1%]), hs-TNI (38 [48.1%] vs 6 [1.0%]), α- HBDH (55 [10.4%] vs 2 [0.2%]), CK-MB (45 [36.3%] vs 12 [0.9%]), and LDH (56 [12.5%] vs 1 [0.1%]) had a significantly higher mortality rate compared to patients with normal levels. The same trend was observed in the ICU admission rate. Severe/critical COVID-19 patients with pre-existing coronary artery disease (165/1,155 [10.9%]) had more cases of BNP (52 [46.5%] vs 119 [16.5%]), hs-TNI (24 [26.7%] vs 9.6 [%], α- HBDH (86 [55.5%] vs 443 [34.4%]), CK-MB (27 [17.4%] vs 97 [7.5%]), and LDH (65 [41.9%] vs 382 [29.7%]), when compared with those without coronary artery disease. There was enhanced SARS-CoV-2 receptor expression in coronary artery disease compared with healthy controls. From regression analysis, patients with five elevated cardiac markers were at a higher risk of death (hazards ratio 3.4 [95% CI 2.4–4.8]). Conclusions COVID-19 patients with pre-existing coronary artery disease represented a higher abnormal percentage of cardiac markers, accompanied by high mortality and ICU admission rate. BNP together with hs-TNI, α- HBDH, CK-MB and LDH act as a prognostic biomarker in COVID-19 patients with or without pre-existing coronary artery disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03555-z.
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Affiliation(s)
- Pengping Li
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Wei Wu
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Tingting Zhang
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Ziyu Wang
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Jie Li
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Mengyan Zhu
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Yuan Liang
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Wenhua You
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Kening Li
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Rong Ding
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Bin Huang
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Lingxiang Wu
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Weiwei Duan
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China
| | - Yi Han
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuesong Li
- Key Laboratory of Cardiovascular and Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Xin Tang
- Key Laboratory of Cardiovascular and Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Xin Wang
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Han Shen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qianghu Wang
- Department of Bioinformatics, Nanjing Medical University, Nanjing, China.,Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Hong Yan
- Laboratory Medicine Center, the Second Affiliated Hospital, Nanjing Medical University, Nanjing, China.
| | - Xinyi Xia
- COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. .,Department of Laboratory Medicine & Blood Transfusion, Wuhan Huoshenshan Hospital, Wuhan, China. .,Joint Expert Group for COVID-19, Wuhan Huoshenshan Hospital, Wuhan, China.
| | - Yong Ji
- Key Laboratory of Cardiovascular and Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University, Nanjing, China. .,Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China. .,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China.
| | - Hongshan Chen
- Key Laboratory of Cardiovascular and Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University, Nanjing, China. .,Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China. .,Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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