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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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2
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Lee EWC, Antonelli L, Issa A, Churchill J, Sachdeva A, Oliveira P, Lau M, Sangar V, Parnham A, Fankhauser CD. Risk of Local Recurrence in Men With Penile Intraepithelial Neoplasia in the Surgical Margin After Penile-sparing Surgery. J Urol 2023; 210:778-781. [PMID: 37675864 DOI: 10.1097/ju.0000000000003635] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/13/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Up to 90% of men with a positive surgical margin show remaining cancer in subsequent reresections. The risk of local recurrence in men with no penile cancer but the precancerous lesion penile intraepithelial neoplasia at the surgical margin is less well studied and was the aim of this analysis. MATERIAL AND METHODS This was a retrospective analysis of men with distal penile cancer undergoing penile-sparing surgery. A competing risks survival analysis adjusted for grade, lymphovascular invasion, and stage was performed to assess local recurrence-free survival in patients with penile intraepithelial neoplasia-positive margins and completely negative surgical margins. RESULTS A negative surgical margin was described in 319 men (85%), whereas penile intraepithelial neoplasia in the surgical margin was found in 59 men (15%). Local recurrence was observed in 30/319 men with a negative surgical margin compared to 11/59 men with penile intraepithelial neoplasia in the surgical margin. Adjusted for T stage and grade, patients with penile intraepithelial neoplasia at the surgical margin had a higher risk to develop a local recurrence than those with a negative surgical margin without penile intraepithelial neoplasia (HR 1.51, 95% CI 1.07-2.12, P = .019). CONCLUSIONS Men with a penile intraepithelial neoplasia-positive surgical margin have an increased risk to experience local recurrence compared to men with a negative surgical margin and should undergo closer surveillance and/or adjuvant treatment.
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Affiliation(s)
- Esther W C Lee
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Luca Antonelli
- Policlinico Umberto I, Rome, Italy
- University of Lucerne, Lucerne, Switzerland
| | - Allaudin Issa
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - James Churchill
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ashwin Sachdeva
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Pedro Oliveira
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Maurice Lau
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Vijay Sangar
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Arie Parnham
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Christian D Fankhauser
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- University of Lucerne, Lucerne, Switzerland
- University of Zurich, Zurich, Switzerland
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3
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Naushad N, Deb AA, Agag AA, Serag HA, Sangar VK. Prognostic Markers and Trials in Penile Cancer. Urol Res Pract 2023; 49:138-146. [PMID: 37877863 PMCID: PMC10346112 DOI: 10.5152/tud.2023.22225] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/03/2023] [Indexed: 10/26/2023]
Abstract
New tumor biomarkers open the potential for designing personalized therapy for penile squamous cell carcinoma. Despite the initial promising results of some biomarkers, controversy remains due to contradictory studies. Further robust research work is required before incorporating biomarkers in the personalized management of penile cancer. This narrative review aims to highlight some of the most commonly and recently investigated biomarkers of penile cancer and to summarize the ongoing registered clinical trials for the management of penile cancer patients.
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Affiliation(s)
- Naufal Naushad
- Department of Urology, Christie NHS Foundation Trust, Manchester, UK
| | - Abdalla A. Deb
- Department of Urology, James Cook University Hospital, Middlesbrough, UK
| | - Ayman A. Agag
- Department of Urology, Frimley Park Hospital, Frimley, UK
| | - Hosam A. Serag
- Department of Urology, University Hospitals Birmingham, Birmingham, UK
| | - Vijay K. Sangar
- Department of Urology, Christie NHS Foundation Trust, Manchester, UK
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4
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Huelster HL, Chang A, Rose KM, Bandini M, Albersen M, Roussel E, Chipollini J, Zhu Y, Ye DW, Ornellas AA, Catanzaro M, Marandino L, Pederzoli F, Hakenberg OW, Heidenreich A, Haidl F, Watkin N, Ager M, Ahmed ME, Karnes JR, Briganti A, Kim Y, Montorsi F, Necchi A, Spiess PE. Concomitant vs Staged Therapeutic Inguinal Lymphadenectomy in Clinically Node Positive Penile Squamous Cell Carcinoma: Does It Make a Difference? J Urol 2023; 209:557-564. [PMID: 36652397 DOI: 10.1097/ju.0000000000003099] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Inguinal lymph node dissection within 3 months of primary tumor resection in penile cancer has been associated with longer recurrence-free and cancer-specific survival. However, the optimal timing and effect of lymphadenectomy performed concurrently at the time of primary lesion management on oncologic outcomes in clinically lymph node positive penile squamous cell carcinoma remains unknown. MATERIALS AND METHODS An international, multicenter cohort of 966 penile cancer cases was queried for penile squamous cell carcinoma management after the year 2000, clinically lymph node positive status, and performance of penile surgery and inguinal lymph node dissection. Cohorts were stratified as concomitant if inguinal lymph node dissection and penile surgery occurred on the same date or staged when inguinal lymph node dissection was performed after penile resection. Rates and patterns of penile squamous cell carcinoma recurrence were reported. Distant recurrence-free, cancer-specific, and overall survival were estimated using Kaplan-Meier analyses and groups compared with log-rank testing. RESULTS Of 253 contemporary men with clinically lymph node positive penile squamous cell carcinoma, 96 (38%) underwent concomitant inguinal lymph node dissection and 157 (62%) had inguinal lymph node dissection performed in a staged manner. Penile cancer was most likely to recur distantly (19%) followed by in the groin (14%) or pelvis (5%). There were no differences in distant recurrence-free, cancer-specific, or overall survival between management strategies. Multivariable analysis adjusting for stage, treatment center, and perioperative chemoradiation also demonstrated no recurrence-free, cancer-specific, or overall survival benefit between management strategies. CONCLUSIONS Inguinal lymph node dissection performed concurrently with excision of the penile tumor for clinically node positive penile squamous cell carcinoma is not associated with differences in recurrence-free, cancer-specific, or overall survival compared to staged lymph node dissection.
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Affiliation(s)
| | - Andrew Chang
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kyle M Rose
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Marco Bandini
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Juan Chipollini
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Yao Zhu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ding-Wei Ye
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Antonio A Ornellas
- Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil
| | - Mario Catanzaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Laura Marandino
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Filippo Pederzoli
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | | | | | | | - Nick Watkin
- St George's University Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Michael Ager
- St George's University Hospitals, NHS Foundation Trust, London, United Kingdom
| | | | | | - Alberto Briganti
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Youngchul Kim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Francesco Montorsi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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5
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Muacevic A, Adler JR, Irzi M, Mokhtari M, Barki A. Penile Squamous Cell Carcinoma in a 95-Year-Old Patient: Case Report and Literature Review. Cureus 2022; 14:e32660. [PMID: 36660518 PMCID: PMC9844244 DOI: 10.7759/cureus.32660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Penile cancer is a rare disease. Delay in diagnosis and treatment frequently occurs and high morbidity can be observed in affected patients. The management is based on surgical resection. The inguinal node staging depends on the disease-related risk. We herein report a 95-year-old male patient, with a history of a right inguinal hernia, surgically treated. He presented with a swollen painful glans penis. The glans biopsy identified a moderately differentiated invasive squamous cell carcinoma. We have performed a complete penectomy with a bilateral inguinal lymph node dissection. The patient is currently receiving adjuvant chemotherapy based on cisplatin.
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Abstract
Introduction Although studies using mixed insurance populations suggest that chemotherapy use in men with advanced penile cancer (PC) is low, it is unclear what regimens are being utilized. In this study, we use a database of insured patients to better understand specific chemotherapy utilization in men with PC. Methods This is a retrospective cohort study of patients with stage IIIB or IV PC in the Surveillance, Epidemiology, and End Results-Medicare database (2004-2015). Standard of care (SOC) chemotherapy was defined by the National Comprehensive Cancer Network® guidelines: 4 cycles of paclitaxel, ifosfamide and cisplatin or 5-fluorouracil with cisplatin in the neoadjuvant, adjuvant or primary setting. We calculated what proportion of patients receive SOC or any chemotherapy within 2 years of diagnosis and analyzed what factors were associated with receiving chemotherapy. Results Our study included 147 patients-48 stage IIIB and 99 stage IV. Of these patients, 49 (33%) received chemotherapy. Less than 5% of men received SOC. About 10% received SOC chemotherapy but an insufficient number of cycles. Married men were more likely to undergo chemotherapy (OR 3.4, 95% CI 1.5-7.8). Less than 5% of the 24 Black or Hispanic patients received chemotherapy compared to 37% of white patients (p <0.001). Conclusions Only a third of men with stage IIIB/IV PC underwent chemotherapy. Less than 5% of men received complete guideline-based regimens. Whether this is driven primarily by patient or provider factors is unknown, although social determinants of health may play a role. These data highlight the difficulty for patients with PC to get chemotherapy.
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Affiliation(s)
- Edward Chang
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Sarah Holt
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Bruce Montgomery
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan Wright
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Division of Public Health Sciences, Fred Hutchinson Center Research Center, Seattle, Washington
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7
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Törnävä M, Harju E, Vasarainen H, Pakarainen T, Perttilä I, Kaipia A. Men's experiences of the impact of penile cancer surgery on their lives: A qualitative study. Eur J Cancer Care (Engl) 2021; 31:e13548. [PMID: 34931726 DOI: 10.1111/ecc.13548] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/12/2021] [Accepted: 12/02/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Surgery is the primary treatment for invasive penile cancer (PC). Postoperative changes in genital anatomy and function may lead to altered body and self-image, compromised sexual function and subsequent psychological problems. The aim of this study is to describe men's experiences of the impact of PC surgical treatment on their lives. METHODS The institutional databases of two Finnish university hospitals were searched for patients who underwent surgery for invasive PC between 2009 and 2019. Of 107 men, 29 agreed to an interview or a response letter. The data were analysed by thematic analysis. RESULTS The men experienced that their self-image had changed after PC diagnosis and treatment to a 'cancer-modified me'. They also experienced that physical symptoms after surgery defined their everyday, as well as sexual, lives and that the whole content of life changed. CONCLUSION Support and counselling for physical, mental, sexual and social factors should be part of the treatment of men with PC.
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Affiliation(s)
- Minna Törnävä
- Department of Physical and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland.,School of Health and Social Services, Tampere University of Applied Sciences, Tampere, Finland
| | - Eeva Harju
- Department of Surgery, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Nursing Science, Tampere University, Tampere, Finland
| | - Hanna Vasarainen
- Department of Urology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Tomi Pakarainen
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Ilkka Perttilä
- Department of Urology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Antti Kaipia
- Department of Surgery, Tampere University Hospital, Tampere, Finland
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8
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Lebentrau S, Wakileh GA, Schostak M, Schmid HP, Suarez-Ibarrola R, Merseburger AS, Hutterer GC, Necknig UH, Rink M, Bögemann M, Kluth LA, Pycha A, Burger M, Brookman-May SD, Bründl J, May M. Does the Identification of a Minimum Number of Cases Correlate With Better Adherence to International Guidelines Regarding the Treatment of Penile Cancer? Survey Results of the European PROspective Penile Cancer Study (E-PROPS). Front Oncol 2021; 11:759362. [PMID: 34912711 PMCID: PMC8667688 DOI: 10.3389/fonc.2021.759362] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background Penile cancer represents a rare malignant disease, whereby a small caseload is associated with the risk of inadequate treatment expertise. Thus, we hypothesized that strict guideline adherence might be considered a potential surrogate for treatment quality. This study investigated the influence of the annual hospital caseload on guideline adherence regarding treatment recommendations for penile cancer. Methods In a 2018 survey study, 681 urologists from 45 hospitals in four European countries were queried about six hypothetical case scenarios (CS): local treatment of the primary tumor pTis (CS1) and pT1b (CS2); lymph node surgery inguinal (CS3) and pelvic (CS4); and chemotherapy neoadjuvant (CS5) and adjuvant (CS6). Only the responses from 206 head and senior physicians, as decision makers, were evaluated. The answers were assessed based on the applicable European Association of Urology (EAU) guidelines regarding their correctness. The real hospital caseload was analyzed based on multivariate logistic regression models regarding its effect on guideline adherence. Results The median annual hospital caseload was 6 (interquartile range (IQR) 3–9). Recommendations for CS1–6 were correct in 79%, 66%, 39%, 27%, 28%, and 28%, respectively. The probability of a guideline-adherent recommendation increased with each patient treated per year in a clinic for CS1, CS2, CS3, and CS6 by 16%, 7.8%, 7.2%, and 9.5%, respectively (each p < 0.05); CS4 and CS5 were not influenced by caseload. A caseload threshold with a higher guideline adherence for all endpoints could not be perceived. The type of hospital care (academic vs. non-academic) did not affect guideline adherence in any scenario. Conclusions Guideline adherence for most treatment recommendations increases with growing annual penile cancer caseload. Thus, the results of our study call for a stronger centralization of diagnosis and treatment strategies regarding penile cancer.
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Affiliation(s)
- Steffen Lebentrau
- Department of Urology, Werner Forßmann Hospital, Eberswalde, Germany
| | | | - Martin Schostak
- Department of Urology and Urooncology, University Medical Center Magdeburg, Magdeburg, Germany
| | - Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Axel S Merseburger
- Department of Urology, University of Schleswig-Holstein, Lübeck, Germany
| | - Georg C Hutterer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Ulrike H Necknig
- Department of Urology and Pediatric Urology, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Bögemann
- Department of Urology and Pediatric Urology, University Medical Center Münster, Münster, Germany
| | - Luis Alex Kluth
- Department of Urology, University Medical Center Frankfurt a.M., Frankfurt/Main, Germany
| | - Armin Pycha
- Department of Urology, Hospital of Bolzano, Bolzano-Bozen, Italy.,Medical School, Sigmund Freud University Vienna, Vienna, Austria
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Sabine D Brookman-May
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Matthias May
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.,Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
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9
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Artiles Medina A, Fraile Poblador A, Hevia Palacios M, Carretero Barrio I, Reguero ME, Rodríguez-Patrón Rodríguez R, Burgos Revilla FJ. Primary epithelioid hemangioendothelioma of the penis: a case report and literature review. Transl Androl Urol 2021; 10:3697-3703. [PMID: 34733664 PMCID: PMC8511538 DOI: 10.21037/tau-21-277] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumour with an intermediate behaviour between benign hemangioma and malignant angiosarcoma. There is scarce data on the penile EHE’s management and its natural history, as our knowledge is based on few reported cases with a short follow-up period. We present a case report and conducted a literature review, including 17 cases. The relevance of this case report derives from the need for better clinical characterization of patients with penile EHE and the importance of defining the outcomes. We report the case of a 53-year-old male with a 1-year history of sleep-related painful erections. Imaging techniques showed a well-defined hypoechoic and hypervascular solid nodule on the dorsal aspect of the penis. It was surgically removed, and the histopathological study revealed a low-risk EHE of the penis. Follow-up magnetic resonance imaging (MRI) and computed tomography did not demonstrate local recurrence nor metastases. According to the literature review, most of the patients were in their fifth and sixth decades of life at the time of diagnosis and lesions were usually located in the glans. The most common clinical presentation was as a painful mass. Follow-up period ranged from 2 months to 5 years. Three patients showed systemic metastases, two of which died due to cancer. The conclusions from the literature review are limited by the reduced number of cases and the short follow-up. This case report highlights the importance of understanding the diagnosis and treatment of this type of rare non-squamous malignant tumours of the penis. Penile EHE is a malignant vascular tumour that is very rare in this location. The best treatment is local excision, with re-excision or intraoperative margins assessment. Occasionally, systemic chemotherapy and radiation therapy can be useful. There is consensus on the importance of very strict follow-up of these patients.
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Affiliation(s)
- Alberto Artiles Medina
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, University of Alcalá, Madrid, Spain
| | - Agustín Fraile Poblador
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, University of Alcalá, Madrid, Spain
| | - Manuel Hevia Palacios
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, University of Alcalá, Madrid, Spain
| | | | | | - Rafael Rodríguez-Patrón Rodríguez
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, University of Alcalá, Madrid, Spain
| | - Francisco Javier Burgos Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, University of Alcalá, Madrid, Spain
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10
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Yang Z, Tan X, Wang Y, Zou Y, Chen D, Wu Z, Liu Z, Li Y, Qin Z, Han H, Zhou F, Yao K. Deep Inguinal Lymph Node Metastases Can Predict Pelvic Lymph Node Metastases and Prognosis in Penile Squamous Cell Carcinoma. Front Oncol 2021; 11:715799. [PMID: 34604052 PMCID: PMC8479104 DOI: 10.3389/fonc.2021.715799] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the relationship between deep inguinal lymph node metastasis (ILNM) and pelvic lymph node metastasis (PLNM) and explore the prognostic value of deep ILNM in penile squamous cell carcinoma (PSCC). MATERIALS AND METHODS The records of 189 patients with ILNM treated for PSCC were analysed retrospectively. Logistic regression models were used to test for predictors of PLNM. Cox regression was performed in univariable and multivariable analyses of cancer-specific survival (CSS). CSS was compared using Kaplan-Meier analyses and log rank tests. RESULTS PLNM were observed in 53 cases (28.0%). According to logistic regression models, only deep ILNM (OR 9.72, p<0.001) and number (≥3) of metastatic inguinal lymph nodes (ILNs) (OR 2.36, p=0.03) were independent predictors of PLNM. The incidences of PLNM were 18% and 19% with negative deep ILNM and extranodal extension (ENE); and 76% and 42% with positive deep ILNM and ENE, respectively. The accuracy of deep ILNM, ENE, bilateral involvement and number (≥3) of ILNMs for predicting PLNM were 81.0%, 65.6%, 63.5% and 67.2%, respectively. The CSS was significantly different in patients with positive and negative deep ILNM (median 1.7 years vs not reached, p<0.01). Patients who presented with deep ILNM had worse CSS (median 3.8 years vs not reached, p<0.01) in those with negative PLNs. CONCLUSIONS Deep ILNM is the most accurate factor for predicting PLNM in PSCC according to our data. We recommend that patients with deep ILNM should be referred for pelvic lymph node dissection. Involvement of deep ILNs indicates poor prognosis. We propose that patients with metastases of deep ILNs may be staged as pN3.
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Affiliation(s)
- Zhenyu Yang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xingliang Tan
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yanjun Wang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuantao Zou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dong Chen
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhiming Wu
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhuowei Liu
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yonghong Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zike Qin
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui Han
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fangjian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Kai Yao
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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11
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Bowie J, Singh S, O’Hanlon C, Shiatis V, Brunckhorst O, Muneer A, Ahmed K. A systematic review of non-HPV prognostic biomarkers used in penile squamous cell carcinoma. Turk J Urol 2021; 47:358-365. [PMID: 35118975 PMCID: PMC9612776 DOI: 10.5152/tud.2021.21199] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/08/2021] [Indexed: 06/14/2023]
Abstract
The presence of lymph node metastasis is the most important prognostic indicator for patients with penile cancer. However, predicting which clinically node negative patients will harbor lymph node metastases remains unclear. The aim of this systematic review is to provide an overview of biomarkers p53, Ki-67, and SCCAg in predicting lymph node metastasis (LNM) and cancer-specific survival (CSS) in penile squamous cell carcinoma (SCC). MEDLINE, EMBASE, Cochrane Library, Scopus, and ClinicalTrials.gov were searched from inception until 15 October 2020. Eligible studies were identified by three independent reviewers. Outcome measures included the presence of penile LNM and CSS. Extracted data were narratively synthesized with GRADE criteria utilized to evaluate the quality of evidence. In total, 999 articles were screened with 20 selected for inclusion. Studies reporting the use of p53 to predict LNM and CSS were rated as having the highest quality of evidence using the GRADE criteria, and the majority showed a positive association between p53 expression and LNM and CSS. All biomarkers and outcome combinations had at least one study showing a significant effect on predicting the outcome. However, studies were heterogeneous, and many reported nonsignificant effects. Identifying p53 overexpression may help one to identify patients at higher risks of LNM to be considered for early inguinal lymphadenectomy. There is contradictory and unreliable evidence for the prognostic value of Ki-67 and SCCAg in penile SCC for LNM and CSS. Larger studies are required with more rigorous methods and reports to improve the evidence base.
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Affiliation(s)
- Jessica Bowie
- Guy's Campus, King's College London School of Bioscience Education, London, UK
| | - Sobha Singh
- Guy's Campus, King's College London School of Bioscience Education, London, UK
| | - Ciaran O’Hanlon
- Guy's Campus, King's College London School of Bioscience Education, London, UK
| | - Vishal Shiatis
- Guy's Campus, King's College London School of Bioscience Education, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, UK
| | - Asif Muneer
- Division of Surgery and Interventional Science, University College London, London, UK
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre, University College London Hospital, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, UK
- Department of Urology, King’s College Hospital, London, UK
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12
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Dos Santos J, Cabrebra R, Neves B, Silva E, Polónia A. Squamous cell carcinoma with sarcomatous transformation of the penis. Autops Case Rep 2021; 11:e2021303. [PMID: 34458171 PMCID: PMC8387073 DOI: 10.4322/acr.2021.303] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/05/2021] [Indexed: 11/26/2022] Open
Abstract
Malignant tumors of the penis are rare, most of them being squamous cell carcinomas (SCCs). We report the case of a 75-year-old man with a large penile mass submitted to partial penectomy. The specimen showed an exophytic mass involving the glans, coronal sulcus, and prepuce. Microscopic examination showed a carcinoma with two distinct areas: a mixed SCC and a sarcomatoid carcinoma. The SCC component had areas of verrucous carcinoma and areas of classical invasive SCC. The tumor cells expressed p63 with the absence of p16 expression. Vimentin and p53 were positive in the sarcomatous component. The morphology and immunohistochemistry were compatible with mixed SCC (verrucous hybrid-sarcomatoid carcinoma). Additionally, the tumor cells also expressed 3 different clones of PDL1 (22C3, SP263, and SP142). Two months later, the patient presented local recurrence with multiple lymph nodes and lung metastases, dying 7 weeks later. Mixed tumors represent diagnostic challenges. The correct identification of adverse prognostic factors can be the first step to implement the treatment with a higher probability of success.
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Affiliation(s)
- Joana Dos Santos
- Unidade Local de Saúde de Matosinhos (ULSM), Department of Pathology, Matosinhos, Porto, Portugal
| | - Rafael Cabrebra
- Instituto Português de Oncologia de Lisboa (IPO Lisboa), Department of Pathology, Lisboa, Lisboa, Portugal
| | - Beatriz Neves
- Universidade do Porto (U. Porto), Institute of Molecular Pathology and Immunology (IPATIMUP), Ipatimup Diagnostics, Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (I3S), University of Porto, Porto, Porto, Portugal
| | - Eduardo Silva
- Instituto Português de Oncologia de Lisboa (IPO Lisboa), Department of Urology, Lisboa, Lisboa, Portugal
| | - António Polónia
- Universidade do Porto (U. Porto), Institute of Molecular Pathology and Immunology (IPATIMUP), Ipatimup Diagnostics, Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (I3S), University of Porto, Porto, Porto, Portugal
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13
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Huang K, Lu S, Wang Y, Tu X. Case Report: Treatment of Penile Intraepithelial Neoplasia in an Asian Male With Reconstructive Plastic Surgery. Front Surg 2021; 8:667417. [PMID: 34262931 PMCID: PMC8273158 DOI: 10.3389/fsurg.2021.667417] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Intraepithelial neoplasia is a special type of squamous cell carcinoma occurring in the skin epidermis. The incidence of penile intraepithelial neoplasia in Asian males is rare. We report the clinical characteristics and treatment process of a case of penile intraepithelial neoplasia in a Chinese man. We treated the disease of this patient by surgical excision of the penile lesion and scrotal flap plastic surgery. After surgery, the shape of the penis was satisfactory, and there was no adverse effect on erection. The pathological results confirmed the diagnosis of penile intraepithelial neoplasia. The pathological features showed that the lesion tissue was covered with squamous epithelium and that there was severe atypical hyperplasia of the lesion epithelium, disordered arrangement of polarity, and an intact basement membrane. The removal of the lesions of penile intraepithelial neoplasia through a wider surgical resection range, combined with the stretchability of a scrotal flap, can achieve a good healing effect of the surgical wound and reduce the possibility of recurrence of penile intraepithelial neoplasia.
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Affiliation(s)
- Kai Huang
- Department of Urology, College of Clinical Medicine, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
| | - Shuai Lu
- Department of Urology, College of Clinical Medicine, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
| | - Yehua Wang
- Department of Urology, College of Clinical Medicine, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
| | - Xiangan Tu
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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14
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Kim SH, Ahn H, Kim KH, Kim DS, Yang HJ. Penile schwannoma mistaken for hemangioma: a rare case report and literature review. Transl Androl Urol 2021; 10:2512-2520. [PMID: 34295737 PMCID: PMC8261408 DOI: 10.21037/tau-21-239] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/05/2021] [Indexed: 12/17/2022] Open
Abstract
Penile neoplasm is uncommon. Schwannomas of the penis are especially rare. For this reason, it is difficult to get an accurate impression to enable decision making. This report primarily deals with the mistaken diagnosis of hemangioma, to the surgery, and the follow-up in real-world. A 38-year-old male patient presented with a palpable mass in the penile root that increased in size with erection. One year after the mass had been found, the patient visited the hospital and complained that the mass was growing. Moreover, the patient explained that the mass seemed to increase during penile erection. On physical examinations, a 2 cm mass without tenderness was palpated in the left penoscrotal junction. About 2.1 cm in size, an isoechoic mass was observed next to the corpus cavernosum on ultrasonography. There was high vascularity inside of the mass. Excision and biopsy were decided upon. Following surgery, a schwannoma was confirmed by pathology. After three months, the patient did not complain of any symptoms and had normal erectile function. Most of these tumors are benign. By December 2020, 40 cases were reported, of which 6 were diagnosed as malignant. The most frequent occurrence site is the penile shaft. In all cases, surgical resection was performed and no recurrence was found. The aim of this case report is to assist clinicians in choosing the best treatment option when faced with this rare condition by discussing the radiological, pathological, and clinical course.
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Affiliation(s)
- Si Hyun Kim
- Department of Urology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyein Ahn
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Ki Hong Kim
- Department of Urology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Doo Sang Kim
- Department of Urology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hee Jo Yang
- Department of Urology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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15
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Chakiryan NH, Dahmen A, Bandini M, Pederzoli F, Marandino L, Albersen M, Roussel E, Zhu Y, Ye DW, Ornellas AA, Catanzaro M, Hakenberg OW, Heidenreich A, Haidl F, Watkin N, Ager M, Chahoud J, Briganti A, Salvioni R, Montorsi F, Necchi A, Spiess PE. Patterns of Recurrence following Inguinal Lymph Node Dissection for Penile Cancer: Optimizing Surveillance Strategies. J Urol 2021; 206:960-969. [PMID: 34032492 DOI: 10.1097/ju.0000000000001790] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Our primary objective is to detail the incidence, site, and timing of penile squamous cell carcinoma (pSCC) recurrence after inguinal lymph node dissection (ILND). MATERIALS AND METHODS We performed a retrospective analysis of 551 patients who underwent ILND for pSCC from 2000 to 2017. The primary outcome was pSCC recurrence after ILND. Recurrences were identified and stratified by site. Timing of recurrence was determined. Multivariable logistic regression analysis determined associations with recurrence. Multivariable Cox regression analysis determined associations with overall survival (OS). Sub-group analysis of the distant recurrences analyzed timing and OS by site of distant recurrence. RESULTS After ILND pSCC recurred in 176 (31.9%) patients. Median time to recurrence was 10 months for distant recurrences, 12 for inguinal, 10.5 for pelvic, and 44.5 for local. Greater than 95% of distant, inguinal, and pelvic recurrences occurred within 48 months of ILND, versus 127 months for local recurrences. Post-ILND recurrence was associated with pN2 (OR 1.99, 95% CI 1.0-4.1), and pN3 (OR 7.2, 95% CI 4.0-13.7). Patients who had local recurrence had similar OS to those without (HR 1.5, 95% CI 0.6-3.8), and worse OS was identified in patients with inguinal (HR 4.5, 95% CI 2.8-7.1), pelvic (HR 2.6, 95% CI 1.5-4.5), or distant (HR 4.0, 95% CI 2.7-5.8) recurrences. Patients with lung recurrences had worse OS than other sites (HR 2.2, 95% CI 1.1-4.3). CONCLUSIONS Of the patients 31.9% had post-ILND recurrence associated with high pN staging. Greater than 95% of distant, inguinal, and pelvic recurrences occurred within 48 months, suggesting surveillance beyond this is low yield. Local recurrences occurred over a longer timeline, emphasizing necessity of long-term surveillance of the primary site.
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Affiliation(s)
- Nicholas H Chakiryan
- H. Lee Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, Florida
| | - Aaron Dahmen
- University of South Florida, Department of Urology, Tampa, Florida
| | - Marco Bandini
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Pederzoli
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Marandino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Yao Zhu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ding-Wei Ye
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Antonio A Ornellas
- Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil
| | - Mario Catanzaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | | | - Jad Chahoud
- H. Lee Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, Florida
| | - Alberto Briganti
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Francesco Montorsi
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Philippe E Spiess
- H. Lee Moffitt Cancer Center, Department of Genitourinary Oncology, Tampa, Florida
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16
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Nazzani S, Catanzaro M, Biasoni D, Maccauro M, Zaborra C, Stagni S, Torelli T, Macchi A, Tesone A, Lorenzoni A, Piva L, Lanocita R, Colecchia M, Montanari E, Salvioni R, Pizzocaro G, Nicolai N. Clinical Outcomes in Clinical N0 Squamous Cell Carcinoma of the Penis According to Nodal Management: Early, Delayed or Selective (following Dynamic Sentinel Node Biopsy) Inguinal Lymph-Node Dissection. J Urol 2021; 206:354-63. [PMID: 33843260 DOI: 10.1097/JU.0000000000001775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated the oncologic efficacy of early inguinal lymph-node dissection, observation or dynamic sentinel node biopsy followed by delayed or selective inguinal lymph-node dissection in cN0 patients with penile squamous cell carcinoma. MATERIALS AND METHODS Between 1980 and 2017 (inclusive), 296 evaluable consecutive cN0 penile squamous cell carcinoma patients underwent early inguinal lymph-node dissection (16), observation (114) or dynamic sentinel node biopsy (166). Median followup was 50 months. Tumor stage, grade, lympho-vascular invasion and age were considered. Kaplan-Meier plots illustrated 5-year inguinal relapse-free and cancer specific survival rates. Multivariable Cox regression models tested the treatment effect. Analyses were repeated after inverse probability of treatment weighting adjustment. RESULTS The 5-year inguinal relapse-free survival and cancer specific survival rates following early, observation and dynamic sentinel node biopsy inguinal lymph-node dissection were 100%, 87%, 89%, and 84%, 81%, 85%, respectively. The 5-year crude inguinal relapse-free survival and cancer specific survival rates were 90% and 93% in low-risk patients undergoing observation. Clavien grade 3 complications were 0.6 vs 12.5% in the dynamic sentinel node biopsy and early inguinal lymph-node dissection group, respectively. After inverse probability after treatment weighting adjustment, 5-year inguinal relapse and cancer specific survival were 90% vs 73% and 90% vs 77% following dynamic sentinel node biopsy and observation, respectively. At multivariable Cox regression model, patients undergoing dynamic sentinel node biopsy had significantly lower inguinal relapse (HR 0.4, 95% CI 0.2-0.85, p 0.02) and cancer specific mortality (HR 0.29, 95% CI 0.11-0.77; p=0.01) compared to those under observation. The low number of patients undergoing early inguinal lymph-node dissection made a reliable comparison with this group impractical. CONCLUSIONS Selective inguinal lymph-node dissection following dynamic sentinel node biopsy significantly improved inguinal relapse and cancer specific mortality when compared with observation, providing evidence of efficacy of dynamic sentinel node biopsy in clinical stage N0 squamous cell carcinoma of the penis.
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17
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Yao K, Chen Y, Ye Y, Wu Z, Chen D, Han H, Li Z, Liu Z, Wang Y, Qin Z, Li Y, Li Z, Zhou F. Lymph Node Mapping in Patients with Penile Cancer Undergoing Pelvic Lymph Node Dissection. J Urol 2021; 205:145-151. [PMID: 32755338 DOI: 10.1097/ju.0000000000001322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE A map of pelvic lymph node metastasis in patients with penile cancer helps to clarify the pattern of pelvic spread and define the reasonable limits of dissection, and it has not been established. We aim to provide an accurate map of lymph node metastasis in patients with penile cancer and determine the reasonable extent of pelvic lymph node dissection. MATERIALS AND METHODS We enrolled patients with penile cancer undergoing pelvic lymph node dissection (128) at our institution from 1999 to 2018. The numbers of removed lymph nodes and positive lymph nodes at 10 distinct regions were recorded. The chi-square and Fisher exact tests were used. RESULTS The median number of pelvic lymph nodes retrieved was 18 (IQR 10-30), with the majority being from the external iliac package (43.0%) and obturator package (31.9%). Pelvic lymph node metastasis was present in 57/128 (44.5%) patients. The median number of positive pelvic lymph nodes removed was 2 (IQR 1-4), with the majority being from the external iliac package (50.0%) and obturator package (36.6%). Advanced T-stage was related to higher risk of pelvic lymph node metastasis, which was present in 30.3%, 44.2%, 59.0% and 58.3% of patients with pT1, pT2, pT3 and pT4, respectively. Notably, 2 patients had crossover metastasis from 1 inguinal region to the contralateral pelvic region. CONCLUSIONS We present a detailed map of pelvic lymph node metastasis in patients with penile carcinoma. The external iliac and obturator packages appear to be most commonly involved. Optimal pelvic lymph node dissection may extend to the common iliac artery, including common iliac, external iliac, internal iliac and obturator lymph nodes. Extranodal extension in inguinal nodes may not be as important as previously thought.
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Affiliation(s)
- Kai Yao
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yue Chen
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yunlin Ye
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhiming Wu
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Dong Chen
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hui Han
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zaishang Li
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhuowei Liu
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yanjun Wang
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zike Qin
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yonghong Li
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhiyong Li
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Fangjian Zhou
- Key Laboratory of Oncology in Southern China, Guangzhou, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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18
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van der Fels CAM, Palthe S, Buikema H, van den Heuvel MC, Leliveld A, de Jong IJ. Potential Receptors for Targeted Imaging of Lymph Node Metastases in Penile Cancer. Diagnostics (Basel) 2020; 10:E694. [PMID: 32942549 DOI: 10.3390/diagnostics10090694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022] Open
Abstract
Imaging modalities using tumor-directed monoclonal antibodies may be of value to improve the pre- and intraoperative detection and resection of lymph node (LN) metastatic disease in penile squamous cell carcinoma (PSCC). We investigated the expression of prostate-specific membrane antigen (PSMA), vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR) and epithelial cell adhesion molecule (EpCAM) to analyze their potency for diagnostic applications. Antigen expression was determined in primary tumors and LNs with and without metastases of 22 patients with PSCC. The total immunostaining score (TIS, 0–12) was determined as the product of a proportion score (PS, 0–4) and an intensity score (IS, 0–3). EGFR and VEGF expression were high in primary tumor (median TIS 8) and LN metastases (median TIS 6 and 8, respectively). No EGFR expression was seen in LNs without metastases. However, LNs without metastases did show VEGF expression (median TIS 6). No EpCAM or PSMA expression was seen in PSCC. This study shows that VEGF and EGFR expression is moderate to high in LN metastases of PSCC. Both VEGF and EGFR warrant further clinical evaluation to determine their value as a target for pre- and intraoperative imaging modalities in the detection of LN metastases in PSCC.
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19
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Abstract
Penile metastasis rarely occurs as a unique and early distant recurrence of urothelial bladder carcinoma. A 77-year-old male underwent a radical cystoprostatecomy for a pT3a urothelial bladder cancer. Preoperative imaging workup concluded to a disease confined to the bladder. The patient consulted 5 months later for a penile induration. Computed tomography imaging revealed a suspicious penile nodule with no other nodal or visceral lesion. Total penectomy after a confirmatory biopsy confirmed the infiltration of the corpora cavernosa, the corpus spongiosum and the urethra by a urothelial metastasis of bladder cancer. Distant recurrences after radical surgery for locally advanced bladder cancer may occur as a unique early metastasis located to the penis. We hereby present the case of a 77-year-old male who presented with a recurrence of his bladder carcinoma located solely to the penis. This was confirmed by dedicated imaging. The patient had undergone a radical cystoprostatectomy for an invasive bladder tumor 5 months earlier. The imaging workup performed preoperatively concluded that the tumor was confined to the bladder. The definitive pathological report concluded then to a complete resection of the bladder tumor.
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20
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Sirithanaphol W, Sookprasert A, Rompsaithong U, Kiatsopit P, Wirasorn K, Chindaprasirt J. Prognostic Factors for Penile Cancer and Survival in Response to Multimodality Therapy. Res Rep Urol 2020; 12:29-34. [PMID: 32104668 PMCID: PMC7024792 DOI: 10.2147/rru.s238147] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/28/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To report treatment outcomes of penile cancer in a single institution in Thailand and to identify prognostic factors for survival, highlighting the crucial role of multi-modality treatment (MMT). Patients and Methods Squamous cell carcinoma of penis patients who were treated at Srinagarind hospital between 2007–2015 were retrospectively analyzed. Clinical and pathological data were retrospectively reviewed. Overall survival (OS) was calculated using the Kaplan-Meier method and data were compared using the Log rank test. Cox regression analysis of factors affecting survival was conducted. Results A total of 70 patients were identified with a median follow-up of 69.4 months. Twenty-eight patients (40%) presented with early-stage (stage I or II), whereas 42 patients (60%) were stage III or IV disease. The median OS was 29.3 months (Interquartile range 10.5 months - not reached) for the entire cohort. Nodal involvement was the only factor identified from the multivariate model with the adjusted HR or 5.74 (95% CI 2.52–13.04). For patients with stage IIIB/IV, multi-modality treatment (MMT) resulted in longer survival when compared with surgery alone (HR 0.37; 95% CI 0.16–0.90). Conclusion Patients with penile cancer in Thailand presented with younger age and more locally advanced stage. Nodal involvement is the single poor prognostic factor for OS and MMT was associated with longer survival in stage IIIB/IV disease.
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Affiliation(s)
- Wichien Sirithanaphol
- Division of Urologic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Aumkhae Sookprasert
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ukrit Rompsaithong
- Division of Urologic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pakorn Kiatsopit
- Division of Urologic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kosin Wirasorn
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Jarin Chindaprasirt
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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21
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Azizi M, Aydin AM, Hajiran A, Lai A, Kumar A, Peyton CC, Minhas S, Sonpavde GP, Chahoud J, Pagliaro LC, Necchi A, Spiess PE. Systematic Review and Meta-Analysis-Is there a Benefit in Using Neoadjuvant Systemic Chemotherapy for Locally Advanced Penile Squamous Cell Carcinoma? J Urol 2020; 203:1147-1155. [PMID: 31928407 DOI: 10.1097/ju.0000000000000746] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Neoadjuvant chemotherapy is a recommended treatment for patients with penile cancer with bulky inguinal lymphadenopathy or unresectable primary tumors, although there is no evidence of its benefit from randomized trials. MATERIALS AND METHODS We conducted a systematic search in Embase® and MEDLINE® for studies reporting on patients who received preoperative neoadjuvant chemotherapy for locally advanced penile squamous cell carcinoma. Objective response rate, pathological complete response, grade 3 or greater toxicity and overall mortality were evaluated in terms of neoadjuvant chemotherapy type, which was dichotomized as nontaxane-platinum and taxane-platinum regimens. RESULTS Overall 10 studies met the inclusion criteria, enrolling a total of 182 patients, with 66 (36.3%) and 116 (63.7%) treated with nontaxane-platinum and taxane-platinum regimens, respectively. The pooled results demonstrated an objective response rate of 53% (95% CI 42-64), pathological complete response rate of 16%, grade 3 or greater toxicity rate of 40% (95% CI 19-64) and overall mortality of 55% (95% CI 40-70) in patients treated with neoadjuvant chemotherapy. Stratified subanalysis revealed an objective response rate of 55% and 49%, a pathological complete response of 9% and 20%, a toxicity rate of 26% and 49%, and an overall mortality of 54% and 58% for nontaxane-platinum vs taxane-platinum regimens, respectively. CONCLUSIONS The pooled findings in this study suggest that approximately 50% of the patients with bulky regional lymph node metastases from penile cancer respond to platinum based neoadjuvant chemotherapy and approximately 16% of patients achieve a pathological complete response. Nontaxane based regimens appear to be better tolerated than taxane regimens based on reported grade 3 or greater adverse events (26% vs 49%). Ultimately the robustness of these observations should be interpreted with an awareness of the inherent limitations of deriving data from a collection of small, heterogeneous series.
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Affiliation(s)
- Mounsif Azizi
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ahmet M Aydin
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ali Hajiran
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Andrew Lai
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
| | - Ambuj Kumar
- Division of Evidence Based Medicine and Health Outcomes Research, University of South Florida, Tampa, Florida
| | - Charles C Peyton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Guru P Sonpavde
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Andrea Necchi
- Department of Urology and Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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22
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Li Z, Li X, Zhang X, Chen P, Wang B, Chen X, Han H, Zhou F. Prognostic significance of common preoperative laboratory variables in penile squamous cell carcinoma. Int J Urol 2019; 27:76-82. [PMID: 31663174 DOI: 10.1111/iju.14137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/19/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the predictive value of common preoperative laboratory variables in patients undergoing bilateral inguinal lymph node dissection surgery for penile squamous cell carcinoma. METHODS We retrospectively analyzed the records of 228 patients who had bilateral inguinal lymph node dissection for penile squamous cell carcinoma to assess the following clinical factors: preoperative laboratory measurements, white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, serum calcium, total protein, globulin, pathological factors and survival rates after surgery. RESULTS The percentage of positive lymph nodes was 52.6%. Univariate analysis showed that the tumor stage and grade, the presence of metastasis, white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and globulin were significantly associated with the disease-specific survival (all P < 0.05). At multivariate analysis, only the neutrophil-to-lymphocyte ratio had an independent effect (hazard ratio 2.131; P = 0.035). The predictive accuracy of the neutrophil-to-lymphocyte ratio was the best among the laboratory variables. The predictive accuracy of the basic pathological factors was significantly increased by incorporating the neutrophil-to-lymphocyte ratio prognosticator. CONCLUSION The neutrophil-to-lymphocyte ratio before inguinal lymph node dissection might be useful for predicting the prognosis of patients with penile squamous cell carcinoma.
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Affiliation(s)
- Zaishang Li
- Department of Urology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China.,Department of Urology, The Second Clinical College of Jinan University, Shenzhen, China.,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Xueying Li
- Department of Medical Oncology, The Seventh Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xueqi Zhang
- Department of Urology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China.,Department of Urology, The Second Clinical College of Jinan University, Shenzhen, China
| | - Peng Chen
- Department of Urology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumchi, China
| | - Bin Wang
- Department of Urology, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Xiaofeng Chen
- Department of Urology, The First People's Hospital of Chenzhou, Chenzhou, China
| | - Hui Han
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Fangjian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in Southern China, Guangzhou, China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
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23
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Wei Z, Yu Z, Li H, Peng W, Zhang J, Zhang Y, Song W, Liu J, Yang W, Wang T. The appropriate number of negative lymph nodes dissection for nonmetastatic penile cancer. Andrologia 2018; 51:e13154. [PMID: 30255596 DOI: 10.1111/and.13154] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/01/2018] [Accepted: 08/21/2018] [Indexed: 11/28/2022] Open
Abstract
Negative lymph nodes status has been attached more attention as a prognostic indicator for nonmetastatic penile cancer. We aimed to identify the appropriate number of negative lymph nodes dissection for nonmetastatic penile cancer using the Surveillance, Epidemiology and End Results database. A total of 1,470 nonmetastatic patients with penile squamous cell carcinoma were identified during 2004 and 2013. All patients were categorised according to different risk levels and lymphadenectomy. Univariate and multivariate Cox regression analyses were performed to evaluate the relationship between prognostic risk factors and cancer-specific survival. The optimal cut-off value of negative lymph nodes dissection was determined using the X-Tile program. A total of 1,470 patients were categorised into low- (pT1G1), intermediate- (pT1G2) or high-risk (pT1G3 and all higher stages) groups. In multivariate Cox analysis, lymphadenectomy improved the cancer-specific survival for patients in high-risk group (p = 0.014). Further, the optimal cut-off value of negative lymph nodes dissection for high-risk patients was 5 and patients with >5 negative lymph nodes had a higher cancer-specific survival (χ2 = 9.3676, p < 0.05). Therefore, lymphadenectomy improved survival for high-risk penile cancer and the removal of more than five negative lymph nodes was correlated with higher cancer-specific survival for high-risk patients who underwent lymphadenectomy.
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Affiliation(s)
- Zhewen Wei
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhe Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Peng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junfeng Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weimin Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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24
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Zhou QH, Deng CZ, Chen JP, Huang KB, Liu TY, Yao K, Liu ZW, Qin ZK, Li YH, Guo SJ, Ye YL, Zhou FJ, Huang W, Liu RY, Han H. Elevated serum LAMC2 is associated with lymph node metastasis and predicts poor prognosis in penile squamous cell carcinoma. Cancer Manag Res 2018; 10:2983-2995. [PMID: 30214293 PMCID: PMC6118283 DOI: 10.2147/cmar.s171912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Molecular biomarkers, especially serologic factors, have been widely applied in cancer diagnosis and patient follow-up. However, there are few valuable prognostic factors in penile squamous cell carcinoma (PSCC). Here, the authors investigated whether laminin gamma 2 (LAMC2) expression, especially serum LAMC2 (sLAMC2) level, was a suitable prognostic factor that could aid in the prediction of survival in PSCC. Patients and methods This study included 114 PSCC patients. Reverse transcription-quantitative polymerase chain reaction, Western blotting, and immunohistochemistry were performed to detect LAMC2 expression; enzyme-linked immunosorbent assays were used to test sLAMC2 concentration; and a Transwell assay and an in vivo experiment in nude mice were used to test PSCC cell migration, invasion, and metastasis. The chi-squared test was used to analyze the association between LAMC2 level and clinical parameters, the Cox proportional hazards regression model was used to evaluate the hazard ratio for death, and Kaplan–Meier analysis with a log-rank test was used for the survival analysis. Results LAMC2 was overexpressed in PSCC tissues, and the LAMC2 expression level was higher in metastatic lymph node (LN) tissues than in primary cancer tissues; moreover, the LAMC2 levels in primary cancer tissues and sLAMC2 were higher in patients with LN metastasis than in those without LN metastasis. Upregulated LAMC2 facilitated the migration, invasion, and epithelial-to-mesenchymal transition of PSCC cells in vitro and promoted LN metastasis of PSCC cells in nude mice. Elevated LAMC2 levels were strongly correlated with advanced clinicopathologic parameters, especially LN metastasis, in PSCC patients and predicted shorter disease-specific survival. The predictive value of sLAMC2 is superior to that of C-reactive protein and squamous cell carcinoma antigen previously reported in PSCC patients, and a stratification analysis revealed that the level of sLAMC2 had a higher predictive value for disease-specific survival in early penile cancer (especially at the N0/X stage) than in later-stage penile cancer. Conclusion These findings suggest that sLAMC2 is a potential serologic prognostic marker in PSCC and could aid in risk stratification in early-stage PSCC patients.
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Affiliation(s)
- Qiang-Hua Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China,
| | - Chuang-Zhong Deng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ;
| | - Jie-Ping Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ;
| | - Kang-Bo Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China,
| | - Ting-Yu Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China,
| | - Kai Yao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China,
| | - Zhuo-Wei Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China,
| | - Zi-Ke Qin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China,
| | - Yong-Hong Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China,
| | - Sheng-Jie Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China,
| | - Yun-Lin Ye
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China,
| | - Fang-Jian Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China,
| | - Wenlin Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Guangdong Provincial Key Laboratory of Tumor Targeted Drugs, Guangzhou Enterprise Key Laboratory of Gene Medicine, Guangzhou Doublle Bioproducts Co. Ltd., Guangzhou, China
| | - Ran-Yi Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ;
| | - Hui Han
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China,
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25
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Boda D, Docea AO, Calina D, Ilie MA, Caruntu C, Zurac S, Neagu M, Constantin C, Branisteanu DE, Voiculescu V, Mamoulakis C, Tzanakakis G, Spandidos DA, Drakoulis N, Tsatsakis AM. Human papilloma virus: Apprehending the link with carcinogenesis and unveiling new research avenues (Review). Int J Oncol 2018; 52:637-655. [PMID: 29393378 PMCID: PMC5807043 DOI: 10.3892/ijo.2018.4256] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [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: 09/09/2017] [Accepted: 12/28/2017] [Indexed: 12/17/2022] Open
Abstract
Human papilloma viruses (HPV) are a small group of non‑enveloped viruses belonging to the Papillomaviridae family with strong similarities to polyoma viruses. The viral particles consist of a genome in the form of a circular double‑stranded DNA, encompassing eight open reading frames, as well as a non‑enveloped icosahedral capsid. HPV infection is considered the most common sexually transmitted disease in both sexes and is strongly implicated in the pathogenesis of different types of cancer. 'High‑risk' mucosal HPV types, predominantly types 16, 18, 31, 33 and 35, are associated with most cervical, penile, vulvar, vaginal, anal, oropharyngeal cancers and pre‑cancers. Screening for HPV is necessary for the prognosis and for determining treatment strategies for cancer. Novel HPV markers, including proteomic and genomic markers, as well as anti‑papillomavirus vaccines are currently available. The aim of this comprehensive review was to thoroughly present the updated information on virus development, cancer occurrence, treatment and prevention strategies, in an attempt to shed further light into the field, including novel research avenues.
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Affiliation(s)
- Daniel Boda
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, 030167 Bucharest
- Department of Dermatology, ‘Prof. N. Paulescu’ National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest
| | | | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova
| | - Mihaela Adriana Ilie
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, 030167 Bucharest
- Department of Biochemistry
| | - Constantin Caruntu
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, 030167 Bucharest
- Department of Dermatology, ‘Prof. N. Paulescu’ National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest
- Department of Physiology
| | - Sabina Zurac
- Department of Pathology, ‘Carol Davila’ University of Medicine and Pharmacy, 030167 Bucharest
- Colentina University Hospital, Sector 2 19-21, Bucharest
| | - Monica Neagu
- ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest
| | | | | | - Vlad Voiculescu
- Department of Dermatology and Allergology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School
| | | | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Crete
| | - Nikolaos Drakoulis
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens
| | - Aristides M. Tsatsakis
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
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26
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Li ZS, Chen P, Yao K, Wang B, Li J, Mi QW, Chen XF, Zhao Q, Li YH, Chen JP, Deng CZ, Ye YL, Zhong MZ, Liu ZW, Qin ZK, Lin XT, Liang WC, Han H, Zhou FJ. Development of a new outcome prediction model for Chinese patients with penile squamous cell carcinoma based on preoperative serum C-reactive protein, body mass index, and standard pathological risk factors: the TNCB score group system. Oncotarget 2018; 7:21023-33. [PMID: 26980738 PMCID: PMC4991509 DOI: 10.18632/oncotarget.8037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/24/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose To determine the predictive value and feasibility of the new outcome prediction model for Chinese patients with penile squamous cell carcinoma. Results The 3-year disease-specific survival (DSS) was 92.3% in patients with < 8.70 mg/L CRP and 54.9% in those with elevated CRP (P < 0.001). The 3-year DSS was 86.5% in patients with a BMI < 22.6 Kg/m2 and 69.9% in those with a higher BMI (P = 0.025). In a multivariate analysis, pathological T stage (P < 0.001), pathological N stage (P = 0.002), BMI (P = 0.002), and CRP (P = 0.004) were independent predictors of DSS. A new scoring model was developed, consisting of BMI, CRP, and tumor T and N classification. In our study, we found that the addition of the above-mentioned parameters significantly increased the predictive accuracy of the system of the American Joint Committee on Cancer (AJCC) anatomic stage group. The accuracy of the new prediction category was verified. Methods A total of 172 Chinese patients with penile squamous cell cancer were analyzed retrospectively between November 2005 and November 2014. Statistical data analysis was conducted using the nonparametric method. Survival analysis was performed with the log-rank test and the Cox proportional hazard model. Based on regression estimates of significant parameters in multivariate analysis, a new BMI-, CRP- and pathologic factors-based scoring model was developed to predict disease-specific outcomes. The predictive accuracy of the model was evaluated using the internal and external validation. Conclusion The present study demonstrated that the TNCB score group system maybe a precise and easy to use tool for predicting outcomes in Chinese penile squamous cell carcinoma patients.
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Affiliation(s)
- Zai-Shang Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.,State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China
| | - Peng Chen
- Department of Urology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumchi, P. R. China
| | - Kai Yao
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.,State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China
| | - Bin Wang
- Department of Urology, Cancer Center of Guangzhou Medical University, Guangzhou, P. R. China
| | - Jing Li
- Department of Urology, Cancer Center of Guangzhou Medical University, Guangzhou, P. R. China
| | - Qi-Wu Mi
- Department of Urology, Dong Guan People's Hospital, Guang Dong, P. R. China
| | - Xiao-Feng Chen
- Department of Urology,The First People's Hospital of Chenzhou, Chenzhou, P. R. China
| | - Qi Zhao
- School of Life Science, Sun Yat-sen University, School of Life Science, Guang Dong, P. R. China
| | - Yong-Hong Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.,State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China
| | - Jie-Ping Chen
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.,State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China
| | - Chuang-Zhong Deng
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.,State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China
| | - Yun-Lin Ye
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.,State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China
| | - Ming-Zhu Zhong
- Department of Urology, The People's Hospital of Jiangmen, Jiangmen, P. R. China
| | - Zhuo-Wei Liu
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.,State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China
| | - Zi-Ke Qin
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.,State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China
| | - Xiang-Tian Lin
- Zhongshan School of Medicine, Sun Yat-sen University, Guang Dong, P. R. China
| | - Wei-Cong Liang
- Zhongshan School of Medicine, Sun Yat-sen University, Guang Dong, P. R. China
| | - Hui Han
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.,State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China
| | - Fang-Jian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.,State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China
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27
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Singh A, Jaipuria J, Goel A, Shah S, Bhardwaj R, Baidya S, Jain J, Jain C, Rawal S. Comparing Outcomes of Robotic and Open Inguinal Lymph Node Dissection in Patients with Carcinoma of the Penis. J Urol 2018; 199:1518-1525. [PMID: 29307685 DOI: 10.1016/j.juro.2017.12.061] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE We compared outcomes between robot-assisted video endoscopic inguinal lymphadenectomy and open inguinal lymph node dissection in patients without bulky nodal metastasis in a tandem contemporary cohort. MATERIALS AND METHODS We retrospectively analyzed a prospectively maintained hospital registry of 51 patients who underwent robot-assisted video endoscopic inguinal lymphadenectomy and 100 treated with open inguinal lymph node dissection from 2012 to 2016 for groins without bulky nodal metastasis and who had a minimum 9-month followup. Complications were graded by the Clavien-Dindo classification, and nodal yield and disease recurrence during followup were assessed. Elastic net regression was used to select variables associated with major complications (Clavien 3a or greater) for multivariable analysis of plausible factors, including patient age, diabetes, body mass index, smoking, nodal stage, surgery type, sartorius transposition, saphenous vein transection and adjuvant radiotherapy. Penalized likelihood logistic regression methods were used for multivariate analysis to ascertain final effect sizes while accounting for sparse data bias. RESULTS Robot-assisted video endoscopic inguinal lymphadenectomy and open inguinal lymph node dissection had comparable median lymph node yields (13 vs 12.5). No patient experienced recurrence during the median followup of 40 months. Robot-assisted video endoscopic inguinal lymphadenectomy was associated with significantly lower hospital stay, days needing a drain in situ, incidence of major complications, edge necrosis, flap necrosis and severe limb edema. On multivariable analysis pathological nodal stage (OR 2.8, 95% CI 1.1-6.8, p = 0.027) and open inguinal lymph node dissection (OR 7.5, 95% CI 1.3-43, p = 0.024) emerged as independent risk factors associated with an increased risk of major complications. CONCLUSIONS Robot-assisted video endoscopic inguinal lymphadenectomy is a feasible technique which allows for a similar nodal yield while being associated with lower morbidity than open inguinal lymph node dissection in patients without bulky groin adenopathy.
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Affiliation(s)
- Amitabh Singh
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Jiten Jaipuria
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Amit Goel
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Swati Shah
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Raghubir Bhardwaj
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Saroj Baidya
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Jalaj Jain
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Chirag Jain
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sudhir Rawal
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
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Correa AF, Handorf E, Joshi SS, Geynisman DM, Kutikov A, Chen DY, Uzzo RG, Viterbo R, Greenberg RE, Smaldone MC. Differences in Survival Associated with Performance of Lymph Node Dissection in Patients with Invasive Penile Cancer: Results from the National Cancer Database. J Urol 2017; 199:1238-1244. [PMID: 29248557 DOI: 10.1016/j.juro.2017.11.121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE Inguinal lymphadenectomy remains under performed in patients with invasive penile cancer. Using a large national cancer registry we assessed temporal trends in inguinal lymphadenectomy performance and evaluated the impact of the procedure on survival in patients in whom inguinal lymphadenectomy was an absolute indication (T1b-4 N0/x-1) according to NCCN® (National Comprehensive Cancer Network®) Guidelines®. MATERIALS AND METHODS We queried the National Cancer Database for all cases of nonmetastatic, T1b-4 N0/x-1 squamous cell carcinoma of the penis from 2004 to 2014. Multivariable logistic regression models adjusting for patient, demographic, and clinicopathological characteristics were used to examine the association between available covariates and receipt of inguinal lymphadenectomy. Cox proportional hazards regression analysis was then done to assess the impact of clinical and pathological variables on overall survival. Propensity score weighted analysis was performed to assess the effect of inguinal lymphadenectomy on overall survival. RESULTS A total of 2,224 patients met analysis criteria, of whom 606 (27.2%) underwent inguinal lymphadenectomy. Following adjustment the procedure was more likely in younger patients, those who presented with palpable adenopathy (cN1), those treated at an academic facility and those with a more contemporary diagnosis. On survival analysis controlling for all known and measured confounders inguinal lymphadenectomy was associated with improved overall survival (HR 0.79, 95% CI 0.74-0.84, p <0.001). CONCLUSIONS At hospitals that report to the National Cancer Database the overall rate of inguinal lymphadenectomy in patients with invasive penile cancer was only 27.2%. Inguinal lymphadenectomy was associated with increased overall survival, justifying the procedure as an important quality metric for performance reporting in patients with invasive penile cancer.
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Affiliation(s)
- Andres F Correa
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Department of Urology, Creighton University, Omaha, Nebraska.
| | - Elizabeth Handorf
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Shreyas S Joshi
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Daniel M Geynisman
- Division of Genitourinary Oncology, Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - David Y Chen
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Robert G Uzzo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Rosalia Viterbo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Richard E Greenberg
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Marc C Smaldone
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Kidd LC, Chaing S, Chipollini J, Giuliano AR, Spiess PE, Sharma P. Relationship between human papillomavirus and penile cancer-implications for prevention and treatment. Transl Androl Urol 2017; 6:791-802. [PMID: 29184775 PMCID: PMC5673821 DOI: 10.21037/tau.2017.06.27] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Penile cancer is a rare disease in the United States, but rates are increasing, causing concern. Several risk factors have been associated with the disease, including human papillomavirus (HPV) infection. Knowledge of HPV pathogenesis has led to the development of a vaccine, which has proven instrumental in reducing the incidence of female HPV-related cancers, but results in men have yet to be elucidated. Fortunately, rates of vaccination are up-trending in both males and females in the past several years. In addition, targeted therapies are the focus of several ongoing research efforts. Some of these therapeutics are currently in use, while several are in trials. With continued patient education and research, both treatment and prevention of HPV-related pre-malignant lesions and penile cancer will likely diminish.
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Affiliation(s)
- Laura C Kidd
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sharon Chaing
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Juan Chipollini
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Anna R Giuliano
- Center for Infection Research in Cancer (CIRC), Moffitt Cancer Center, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Pranav Sharma
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Lupu M, Caruntu A, Caruntu C, Papagheorghe LML, Ilie MA, Voiculescu V, Boda D, Constantin C, Tanase C, Sifaki M, Drakoulis N, Mamoulakis C, Tzanakakis G, Neagu M, Spandidos DA, Izotov BN, Tsatsakis AM. Neuroendocrine factors: The missing link in non‑melanoma skin cancer (Review). Oncol Rep 2017; 38:1327-1340. [PMID: 28713981 PMCID: PMC5549028 DOI: 10.3892/or.2017.5817] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 02/23/2017] [Accepted: 06/29/2017] [Indexed: 02/06/2023] Open
Abstract
Non‑melanoma skin cancer (NMSC) is the most common form of cancer worldwide, comprising 95% of all cutaneous malignancies and approximately 40% of all cancers. In spite of intensive efforts aimed towards awareness campaigns and sun‑protective measures, epidemiological data indicate an increase in the incidence of NMSC. This category of skin cancers has many common environmental triggers. Arising primarily on sun‑exposed skin, it has been shown that ultraviolet radiation is, in the majority of cases, the main trigger involved in the pathogenesis of NMSC. Aside from the well‑known etiopathogenic factors, studies have indicated that several neuroactive factors are involved in the carcinogenesis of two of the most common types of NMSC, namely basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), with the exception of penile SCC, for which a paucity of specific data on their pathogenic role exists. The complex interaction between the peripheral nervous system and target cells in the skin appears to be mediated by locally released neuroendocrine factors, such as catecholamines, substance P, calcitonin gene‑related peptide and somatostatin, as well as neurohormones, such as proopiomelanocortin and its derived peptides, α‑melanocyte‑stimulating hormone and adrenocorticotropin. All these factors have been, at least at some point, a subject of debate regarding their precise role in the pathogenesis of NMSC. There is also a significant body of evidence indicating that psychological stress is a crucial impact factor influencing the course of skin cancers, including SCC and BCC. Numerous studies have suggested that neuroendocrine factor dysregulation, as observed in stress reactions, may be involved in tumorigenesis, accelerating the development and progression, and suppressing the regression of NMSC. Further studies are required in order to elucidate the exact mechanisms through which neuroactive molecules promote or inhibit cutaneous carcinogenesis, as this could lead to the development of more sophisticated and tailored treatment protocols, as well as open new perspectives in skin cancer research.
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Affiliation(s)
- Mihai Lupu
- Department of Dermatology, MEDAS Medical Center, 030442 Bucharest, Romania
| | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, ‘Carol Davila’ Central Military Emergency Hospital, 010825 Bucharest, Romania
- ‘Titu Maiorescu’ University, Faculty of Medicine, 031593 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, ‘Prof. N. Paulescu’ National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | | | - Mihaela Adriana Ilie
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Vlad Voiculescu
- Department of Dermatology and Allergology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Carolina Constantin
- ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
- Colentina University Hospital, 020125 Bucharest, Romania
| | - Cristiana Tanase
- ‘Titu Maiorescu’ University, Faculty of Medicine, 031593 Bucharest, Romania
- ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
| | - Maria Sifaki
- Laboratory of Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Nikolaos Drakoulis
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, 71003 Heraklion, Greece
| | - George Tzanakakis
- Laboratory of Anatomy-Histology-Embryology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Monica Neagu
- ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
- Colentina University Hospital, 020125 Bucharest, Romania
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Boris N. Izotov
- Department of Analytical Toxicology, Pharmaceutical Chemistry and Pharmacognosy, Sechenov University, 119991 Moscow, Russia
| | - Aristides M. Tsatsakis
- Laboratory of Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
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Chipollini J, Tang DH, Gilbert SM, Poch MA, Pow-Sang JM, Sexton WJ, Spiess PE. Delay to Inguinal Lymph Node Dissection Greater than 3 Months Predicts Poorer Recurrence-Free Survival for Patients with Penile Cancer. J Urol 2017; 198:1346-1352. [PMID: 28652123 DOI: 10.1016/j.juro.2017.06.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To our knowledge it is unknown whether concomitant inguinal lymph node dissection at the time of penectomy improves outcomes in patients with penile cancer. We analyzed predictors of regional recurrence as well as disease specific survival based on time of inguinal lymph node dissection. We also determined an optimal time to perform inguinal lymph node dissection. MATERIALS AND METHODS We reviewed the records of 84 consecutive patients with available nodal pathology findings. Recurrence-free and disease specific survival was estimated using the Kaplan-Meier method. Optimal time to inguinal lymph node dissection was assessed by ROC curves and used for dichotomization. Cox proportional HRs were used to identify predictors of regional recurrence after inguinal lymph node dissection. RESULTS A total of 47 (56%) and 37 patients (44%) presented with cN0 and cN+ disease, respectively, during a median followup of 21 months. A cutoff point of 3 months to perform inguinal lymph node dissection was used to dichotomize the cohort into early vs delayed groups. Early dissection in 51 men demonstrated 5-year recurrence-free survival of 77% vs 37.8% in 33 who underwent delayed dissection. Positive node disease (HR 23.2, 95% CI 2.98-181.2) and early inguinal lymph node dissection (HR 0.48, 95% CI 0.21-0.98) were predictors of regional recurrence. Five-year disease specific survival was 64.1% and 39.5% in the early and late dissection groups, respectively. CONCLUSIONS Three months appears to be an optimal window for performing inguinal lymph node dissection. While prospective trials are needed to define the role of upfront groin dissection, our results may help delineate patterns of referral and timing of inguinal lymph node dissection in patients with penile cancer.
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Affiliation(s)
- Juan Chipollini
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida.
| | - Dominic H Tang
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Michael A Poch
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Julio M Pow-Sang
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
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Ottenhof SR, Djajadiningrat RS, de Jong J, Thygesen HH, Horenblas S, Jordanova ES. Expression of Programmed Death Ligand 1 in Penile Cancer is of Prognostic Value and Associated with HPV Status. J Urol 2016; 197:690-697. [PMID: 27697578 DOI: 10.1016/j.juro.2016.09.088] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [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] [Accepted: 09/22/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE PD-L1 (programmed death ligand 1) inhibits T-cell function and prevents tumor eradication. This is facilitated by PD-L1 positive tumor cells and PD-L1 positive immune cells, and can be prevented by anti-PD-1 (programmed death 1)/PD-L1 immunotherapy. In advanced penile cancer there is a need for new therapeutic strategies. We investigated PD-L1 expression in penile cancers and compared PD-L1 expression with disease specific survival, lymph node metastases at diagnosis and high risk HPV status in a large patient cohort. MATERIALS AND METHODS A total of 213 primary tumors were immunohistochemically stained for PD-L1 and scored for tumor (percentage), stroma (binary) and PD-L1 positive tumor infiltrating macrophages. Additionally, PD-L1 positive tumors were scored for expression pattern, that is diffuse or predominantly present at the tumor-stroma margin. RESULTS Staining was successful in 200 tumors, of which 75% were high risk HPV negative. Median followup was 62 months. Of 200 tumors 96 (48%) were PD-L1 positive (scored 1% or greater), of which 59 (62%) had a marginal expression pattern and 79 (82%) were high risk HPV negative (p = 0.03). Compared to PD-L1 negative tumors, the PD-L1 expression patterns had different prognostic values in the whole cohort as well as in the high risk HPV negative subgroup. On multivariable analyses a marginal expression pattern was associated with absent lymph node metastases (OR 0.4) while diffuse expression was associated with poor survival (HR 2.58). These results were more prominent in the high risk HPV negative subgroup (OR 0.25, HR 3.92). CONCLUSIONS PD-L1 was expressed in 48% of penile carcinomas and mainly in high risk HPV negative tumors. The pattern of expression was a prognostic factor as marginal expression was associated with absent lymph node metastases and diffuse expression was associated with poor survival.
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Affiliation(s)
- Sarah R Ottenhof
- Department of Urological Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Rosa S Djajadiningrat
- Department of Urological Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen de Jong
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Helene H Thygesen
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urological Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ekaterina S Jordanova
- Center Gynecological Oncology Amsterdam, Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
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Hartz JM, Engelmann D, Fürst K, Marquardt S, Spitschak A, Goody D, Protzel C, Hakenberg OW, Pützer BM. Integrated Loss of miR-1/miR-101/miR-204 Discriminates Metastatic from Nonmetastatic Penile Carcinomas and Can Predict Patient Outcome. J Urol 2016; 196:570-8. [PMID: 26896570 DOI: 10.1016/j.juro.2016.01.115] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Penile squamous cell carcinoma is a rare but aggressive cancer. Little is known about pivotal events in tumor pathogenesis and metastasis. Lymph node metastasis is the prevailing prognostic factor while clinical detection in patients remains difficult. Our aim was to identify distinct miRNAs that are differentially expressed in metastatic vs nonmetastatic penile carcinoma, which may serve as diagnostic biomarkers for disease progression. MATERIALS AND METHODS TaqMan® arrays and quantitative polymerase chain reaction were applied to analyze miRNA profiles in penile squamous cell carcinoma specimens and glans tissue from 24 patients. The prognostic value of deregulated miRNAs was analyzed using the Kaplan-Meier method. The Spearman test was applied to determine a potential linkage between distinctive miRNAs in individual patients. RESULTS Loss of miR-1 (p = 0.0048), miR-101 (p = 0.0001) and miR-204 (p = 0.0004) in metastasizing tumors and associated metastases (p = 0.0151, 0.0019 and 0.0003, respectively) distinguished patients with metastatic and nonmetastatic penile squamous cell carcinoma. These 3 miRNAs showed a coherent expression pattern. Consistently, patients with low levels of all 3 miRNAs had worse survival (p = 0.03). We identified a coordinately regulated miRNA target hub that is over expressed in penile squamous cell carcinoma and associated with lymphovascular invasion. CONCLUSIONS Our results provide evidence of a novel multiple miRNA based signature associated with lymph node metastasis and unfavorable prognosis of penile squamous cell carcinoma. The integrated loss of miR-1, miR-101 and miR-204 may predict the formation of metastases in penile cancer at an early stage.
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Affiliation(s)
- Juliane M Hartz
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - David Engelmann
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany.
| | - Katharina Fürst
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Stephan Marquardt
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Alf Spitschak
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Deborah Goody
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Chris Protzel
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Oliver W Hakenberg
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
| | - Brigitte M Pützer
- Institute of Experimental Gene Therapy and Cancer Research (JMH, DE, KF, SM, AS, DG, BMP), Rostock, Germany; Department of Urology, Rostock University Medical Center, Rostock, Germany
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Dickstein RJ, Munsell MF, Pagliaro LC, Pettaway CA. Prognostic factors influencing survival from regionally advanced squamous cell carcinoma of the penis after preoperative chemotherapy. BJU Int 2015; 117:118-25. [PMID: 25294319 DOI: 10.1111/bju.12946] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe both clinical and pathological response rates, survival, and predictors of survival when using contemporary perioperative chemotherapy and surgical resection for patients with regionally advanced squamous cell carcinoma (SCC) of the penis. PATIENTS AND METHODS Retrospective review of all patients diagnosed with SCC of the penis and regional lymph node metastases that were treated with chemotherapy with the intent to undergo lymphadenectomy. Clinical and pathological responses were reported. Recurrence-free and overall survival was estimated using Kaplan-Meier analysis. Cox proportional hazards regression was used to assess factors for survival. RESULTS In all, 61 patients were identified, of which 54 (90%) received chemotherapy with paclitaxel/ifosfamide/cisplatin. In all, 39 patients (65%) had either a partial (PR) or complete response (CR) to chemotherapy. The 5-year survival varied significantly (P = 0.045-0.001) among patients achieving a CR/PR (50%), stable disease (25%), and progression (7.7%). In all, 10 patients (16.4%) were rendered pN0 with combined therapy and 20 patients (33%) were alive and disease free at a median follow-up of 67 months, while 32 (52%) died from disease. Long-term survival was associated with response to chemotherapy and favourable pathological findings after resection. CONCLUSION Contemporary chemotherapy resulted in clinically significant responses among patients with regionally advanced penile cancer. About 50% of such patients with an objective response to chemotherapy who undergo consolidative lymphadenectomy will remain alive at 5 years.
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Affiliation(s)
- Rian J Dickstein
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lance C Pagliaro
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Li ZS, Yao K, Chen P, Wang B, Chen JP, Mi QW, Li YH, Liu ZW, Qin ZK, Zhou FJ, Han H. Modification of N staging systems for penile cancer: a more precise prediction of prognosis. Br J Cancer 2015; 112:1766-71. [PMID: 25942394 PMCID: PMC4647243 DOI: 10.1038/bjc.2015.141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 11/27/2014] [Revised: 01/27/2015] [Accepted: 03/10/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The tumour-node-metastasis (TNM) classification is the most widely used tool for penile cancer. However, the current system is based on few studies and has been unchanged since 2009. We determined whether a modified pathological N staging system that incorporates the laterality and number of lymph node metastases (LNMs) increases the accuracy of the results in predicting survival compared with the 7th edition of the pathological N staging system of the American Joint Committee on Cancer (AJCC) for penile cancer. METHODS The clinical and histopathologic data from 111 patients with penile cancer with LNMs were analysed. Univariate and multivariate Cox proportional hazard regression analyses were used to determine the impact of the clinical and pathological factors on disease-specific survival of these patients. The predictive accuracy was further assessed using the concordance index. RESULTS According to the 7th edition of the pathological N classification, the 3-year disease-specific survival (DSS) rates for patients with pN1, pN2, and pN3 disease are 89.6%, 65.9%, and 33.6%, respectively (P(N1-N2)=0.030, P(N2-N3)<0.001, P<0.001). Under the modified pathological N category criteria, the 3-year DSS rates for pN1, pN2, and pN3 patients were 90.7%, 60.5%, and 31.4%, respectively (P(N1-N2)=0.005, P(N2-N3)=0.004, P<0.001). In separate multivariate Cox regression models, only modified N stages (hazard ratio: 4.877, 10.895; P=0.018, P<0.001) exhibited independent effects on the outcome. The accuracy of the modified pathological N category was significantly increased. CONCLUSIONS The modified pathological N staging system is a better reflection of the prognosis of patients with penile cancer. Our study should contribute to the improvement of prognostic stratification and systemic treatment to avoid overtreatment of patients.
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Affiliation(s)
- Z-S Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in Southern China, Guangzhou, PR China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - K Yao
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in Southern China, Guangzhou, PR China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - P Chen
- Department of Urology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumchi, PR China
| | - B Wang
- Department of Urology, Cancer Center of Guangzhou Medical University, Guangzhou, PR China
| | - J-P Chen
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in Southern China, Guangzhou, PR China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - Q-W Mi
- Department of Urology, Dong Guan People's Hospital, Guang Dong, PR China
| | - Y-H Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in Southern China, Guangzhou, PR China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - Z-W Liu
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in Southern China, Guangzhou, PR China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - Z-K Qin
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in Southern China, Guangzhou, PR China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - F-J Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in Southern China, Guangzhou, PR China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - H Han
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in Southern China, Guangzhou, PR China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
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Zhu Y, Gu WJ, Wang HK, Gu CY, Ye DW. Surgical treatment of primary disease for penile squamous cell carcinoma: A Surveillance, Epidemiology, and End Results database analysis. Oncol Lett 2015; 10:85-92. [PMID: 26170981 DOI: 10.3892/ol.2015.3221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 03/27/2015] [Indexed: 11/12/2022] Open
Abstract
Current guidelines recommend penile sparing surgery (PSS) for selected penile cancer cases. The present study described the use of PSS in a population-based cohort, and also examined the role of PSS on penile cancer-specific mortality (PCSM). Data from the Surveillance, Epidemiology, and End Results (SEER) database were used to identify individuals that were diagnosed with penile squamous cell carcinoma between 1998 and 2009 and treated with surgery. Patients were sorted into two groups: Local tumor excision (LTE) and partial/total penectomy (PE). Factors associated with the receipt of LTE and PCSM following LTE were examined. In addition, PCSM was compared between LTE and PE following propensity score matching. Of the 1,292 eligible patients, 24.2% underwent LTE. For stage T1 disease, the rates of LTE increased moderately from 29 to 40% over the last decade. Following multivariate analyses, young age, African descent, a tumor size of <3 cm and stage T1 disease were identified to positively influence the receipt of LTE. With a median follow-up period of 55 months, the four-year PCSM rate was 9.8% in patients treated with LTE. Older age, a tumor size of 3-4 cm and regional/distant disease (SEER stage) were significant predictors of PCSM. Furthermore, in matched cohorts with stage T1 disease, the four-year PCSM rates were 8.9 and 10.0% for patients that received LTE or PE, respectively (P=0.93). In conclusion, underuse of PSS is pronounced in the general community with significant age and ethnicity disparities. The current population-based study provides evidence supporting the oncological safety of PSS compared with PE in early-stage disease.
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Affiliation(s)
- Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Wei-Jie Gu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Hong-Kai Wang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Cheng-Yuan Gu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
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de Sousa IDB, Vidal FCB, Branco Vidal JPC, de Mello GCF, do Desterro Soares Brandão Nascimento M, Brito LMO. Prevalence of human papillomavirus in penile malignant tumors: viral genotyping and clinical aspects. BMC Urol 2015; 15:13. [PMID: 25887354 PMCID: PMC4349728 DOI: 10.1186/s12894-015-0007-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 10/20/2014] [Accepted: 02/11/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The human papillomavirus (HPV) prevalence in males has been reported to be between 3.6% and 84%, depending specially on the socioeconomic status. HPV infection has been related as a risk factor for penile cancer. This is a rare tumor, and other risk factors include lack of personal hygiene and men who have not undergone circumcision. Penile cancer is less than 1% of cancers in men in the United States, however, is much more common in some parts of Asia, Africa, and South America, where it accounts for up to 10% of cancers in men. This study aimed to determine the prevalence of HPV-DNA in penile cancers in São Luís, Brazil and to correlate the virus presence to histopathological factors. METHODS Tumor paraffin samples of 76 patients with penile carcinoma were tested in order to establish the prevalence and distribution of genotypic HPV using PCR/Nested and automated sequencing. To evaluate the association between HPV types and other clinical and morphological variables, a nonparametric ANOVA was performed using a Kruskal Wallis test, and statistical significance was determined to a value of p < 0.05. RESULTS The average age of patients at the time of diagnosis was 66 years ± 17.10. Regarding location, 65.79% of the tumors were located in the glans, and the most common types were vegetative (34.21%) and squamous (98.68%). Most of the lesions ranged in size from 2.1 to 5.0 cm, presenting Jackson I stage and Broders II degree. It was observed that 32 patients had at least one invaded and/or infiltrated structure. Lymph node involvement was observed in 19.76% of the patients, and 21.05% showed an inflammatory process. In the molecular evaluation, HPV infection was observed in 63.15% of the lesions, and the most common type was HPV 16. CONCLUSIONS From the statistical analysis, it can be verified that the variables were not associated with infection by the HPV virus. Although penile cancer can result from various risk factors that act in synergy, an HPV virus infection is important for the development of such neoplasm.
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Affiliation(s)
| | - Flávia Castello Branco Vidal
- Tumors and DNA Bank of Maranhão, Federal University of Maranhão (UFMA), São Luís, Brazil.
- Department of Morphology, Federal University of Maranhão (UFMA), São Luís, Brazil.
| | | | | | | | - Luciane Maria Oliveira Brito
- Tumors and DNA Bank of Maranhão, Federal University of Maranhão (UFMA), São Luís, Brazil.
- Department of Medicine III, Federal University of Maranhão (UFMA), São Luís, Brazil.
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Djajadiningrat RS, Horenblas S, Heideman DA, Sanders J, de Jong J, Jordanova ES. Classic and nonclassic HLA class I expression in penile cancer and relation to HPV status and clinical outcome. J Urol 2015; 193:1245-51. [PMID: 25463996 DOI: 10.1016/j.juro.2014.11.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Loss of expression of HLA class I is a mechanism of immune evasion in various cancers that is often associated with a worse patient outcome. We analyzed HLA expression in a large cohort with penile cancer in relation to clinical outcome. MATERIALS AND METHODS We used penile cancer tissue blocks from 168 patients who underwent surgical resection between 2000 and 2009 to construct tissue microarrays. Immunohistochemical staining was done with antibodies directed against classic and nonclassic HLA molecules. HLA expression was scored semiquantitatively, divided into 3 expression groups and correlated with clinicopathological variables, including HPV and survival. Survival analysis was performed using the Kaplan-Meier method and Cox proportional hazards models. RESULTS Complete and partial loss of total classic HLA class I was observed in 32% and 50% of cases, and up-regulation of HLA-E and G in 16% and 13%, respectively. When corrected for relevant clinical parameters, partial HLA-A loss was significantly associated with decreased survival overall (HR 2.3, 95% CI 1.1-4.6) and in HPV negative patients alone (HR 3.4, 95% CI 1.4-8.4). Abnormal HLA-B/C, E or G expression levels were not associated with survival. CONCLUSIONS To our knowledge this is the first study to describe a link between HLA expression and the clinical outcome of penile cancer. HLA down-regulation occurs frequently and partial loss of HLA-A is an independent predictor of poor survival in HPV negative patients. Complete understanding of the mechanisms and relevance of HLA down-regulation and immune evasion in regard to the clinical outcome will contribute to the future design of immunotherapy interventions.
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Djajadiningrat RS, Jordanova ES, Kroon BK, van Werkhoven E, de Jong J, Pronk DTM, Snijders PJF, Horenblas S, Heideman DAM. Human papillomavirus prevalence in invasive penile cancer and association with clinical outcome. J Urol 2014; 193:526-31. [PMID: 25150641 DOI: 10.1016/j.juro.2014.08.087] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 01/21/2023]
Abstract
PURPOSE The incidence of penile cancer is increasing, and is suggested to be explained by changes in sexual practice and increased exposure of men to sexually transmitted high risk human papillomavirus infection. In penile cancers from a Dutch population treated in 1963 to 2001 we found a high risk human papillomavirus prevalence of about 30%. In this study we assessed the prevalence of high risk human papillomavirus-DNA in a more recent, contemporary penile cancer cohort and its association with patient survival. MATERIALS AND METHODS High risk human papillomavirus-DNA presence was assessed by GP5+6+ polymerase chain reaction in 212 formalin fixed, paraffin embedded invasive penile tumor specimens of patients treated between 2001 and 2009. The 5-year disease specific survival was calculated using the Kaplan-Meier method with the log rank test and Cox regression. RESULTS High risk human papillomavirus-DNA was detected in a subset of penile cancer cases (25%, 95% CI 19-31). HPV16 was the predominant type, representing 79% (42 of 53) of all high risk human papillomavirus infections. The 5-year disease specific survival in the high risk human papillomavirus negative group and the high risk human papillomavirus positive group was 82% and 96%, respectively (log rank test p=0.016). Adjusted for stage, grade, lymphovascular invasion and age, human papillomavirus status was still prognostic for disease specific survival (p=0.030) with a hazard ratio of 0.2 (95% CI 0.1-0.9). CONCLUSIONS High risk human papillomavirus-DNA was observed in a quarter of penile cancer cases. No relevant increase in high risk human papillomavirus prevalence in recent decades was observed. The presence of high risk human papillomavirus-DNA in penile cancer confers a survival advantage.
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Affiliation(s)
| | - Ekaterina S Jordanova
- Centre for Gynaecologic Oncology Amsterdam, Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Bin K Kroon
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen de Jong
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Divera T M Pronk
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Carthon BC, Ng CS, Pettaway CA, Pagliaro LC. Epidermal growth factor receptor-targeted therapy in locally advanced or metastatic squamous cell carcinoma of the penis. BJU Int 2014; 113:871-7. [PMID: 24053151 DOI: 10.1111/bju.12450] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of epidermal growth factor receptor (EGFR)-targeted therapy in patients with advanced penile or scrotal cancer. PATIENTS AND METHODS We retrospectively reviewed the charts of patients with penile or scrotal squamous cell carcinoma who had visited our tertiary cancer centre between 2002 and 2009, including their subsequent treatment and follow-up. We collected details of EGFR-targeted therapy and clinical outcomes. Treatment-associated time-to-disease-progression (TTP), overall survival (OS), responses to therapy and toxicity were evaluated. RESULTS A total of 24 patients had received EGFR-targeted therapies, including cetuximab, erlotinib and gefitinib. The most common treatment given (to 67% of patients) was cetuximab combined with one or more cytotoxic drugs. The most common adverse effect was skin rash (71%). The median (range) TTP and OS were 11.3 (1-40) and 29.6 (2-205) weeks, respectively. The OS time for patients with visceral or bone metastases was significantly shorter than it was for those without (24.7 vs 49.9 weeks, P = 0.013). Among 17 patients treated with cetuximab alone or in combination with cisplatin, there were four partial responses (23.5%) including two patients with apparently chemotherapy-resistant tumours. CONCLUSIONS Our results suggest that cetuximab has antitumour activity in metastatic penile cancer, and may enhance the effect of cisplatin-based chemotherapy. Prospective studies of EGFR-targeted therapies in men with these tumours are warranted.
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Affiliation(s)
- Bradley C Carthon
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Yang J, Chen J, Wu XF, Song NJ, Xu XY, Li Q, Qiao D, Zhang JY, Wang W, Su H, Wang ZJ, Su JT, Song NH. Glans preservation contributes to postoperative restoration of male sexual function: a multicenter clinical study of glans preserving surgery. J Urol 2014; 192:1410-7. [PMID: 24769027 DOI: 10.1016/j.juro.2014.04.083] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE We evaluated whether glans preserving surgery would be more helpful for patients to regain satisfactory sexual competency postoperatively than conventional partial amputation. MATERIALS AND METHODS From 2004 to 2012 at 4 centers a total of 135 men treated with glans preserving surgery and 36 treated with partial amputation were selected for evaluation from a total of 273 consecutive patients with penile cancer. Subjective evaluation for patient sexual performance was investigated using the IIEF-15. Objective evaluation was done using the audiovisual sexual stimulation test with the RigiScan® Plus. The degree of satisfaction with penile appearance, and patient confidence and partner acceptability for intercourse were evaluated by 5-point scales. RESULTS Patients treated with glans preserving surgery had better performance in 4 IIEF-15 domains (erectile function, orgasmic function, intercourse satisfaction and overall satisfaction) and 1 RigiScan parameter (tip rigidity) (each p <0.01). They also had significantly higher appearance satisfaction (64.4% vs 13.9%) and intercourse confidence (55.6% vs 5.6%) than men who underwent partial amputation. Sexual partners in the glans preserving group also showed significantly higher appearance satisfaction (51.1% vs 5.6%) and intercourse acceptability (37.8% vs 16.7%) than in the partial amputation group. CONCLUSIONS Glans preserving surgery effectively preserves the functional anatomy and cosmetic appearance of the glans penis. Glans preservation contributes to minimizing postoperative erectile dysfunction and negative psychological impediments, and promotes return to satisfactory sexual performance. Patients treated with glans preservation have more advantages in obtaining sexual acceptance from their partners than those who undergo amputation.
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Affiliation(s)
- Jie Yang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jing Chen
- Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xin-feng Wu
- Institute of Dermatology Surgery, China Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China
| | - Ning-jing Song
- Department of Dermatology, Shanghai Skin Diseases Hospital, Shanghai, People's Republic of China
| | - Xiao-yun Xu
- Department of Dermatology, Jiangsu Province Official Hospital, Nanjing, People's Republic of China
| | - Quan Li
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Di Qiao
- Department of Urology, Jiangsu Province Official Hospital, Nanjing, People's Republic of China
| | - Jia-yi Zhang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Wei Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Huang Su
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Zeng-jun Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jian-tang Su
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Ning-hong Song
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
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Djajadiningrat RS, Graafland NM, van Werkhoven E, Meinhardt W, Bex A, van der Poel HG, van Boven HH, Valdés Olmos RA, Horenblas S. Contemporary management of regional nodes in penile cancer-improvement of survival? J Urol 2013; 191:68-73. [PMID: 23917166 DOI: 10.1016/j.juro.2013.07.088] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE The management of regional nodes of penile squamous cell carcinoma has changed with time due to improved knowledge about diagnosis and treatment. To determine whether changes in the treatment of regional nodes have improved survival, we compared contemporary 5-year cancer specific survival of patients with squamous cell carcinoma of the penis with that of patients in previous cohorts. MATERIALS AND METHODS In an observational cohort study of 1,000 patients treated during 56 years 944 were eligible for analysis. Tumors were staged according to the 2009 TNM classification, and patients were divided into 4 cohorts of 1956 to 1987, 1988 to 1993, 1994 to 2000 and 2001 to 2012, reflecting changes in clinical practice regarding regional nodes. Kaplan-Meier survival curves with the log rank test and Cox proportional hazards modeling were used to examine trends in 5-year cancer specific survival. RESULTS The 5-year cancer specific survival of patients with cN0 disease treated between 2001 and 2012 was 92% compared to 89% (1994 to 2000), 78% (1988 to 1993) and 85% (1956 to 1987). The 5-year cancer specific survival improved significantly since 1994, the year dynamic sentinel node biopsy was introduced, at 91% (1994 to 2012) vs 82% (1956 to 1993) (p = 0.021). This conclusion still holds after adjustment for pathological T stage and grade of differentiation (HR 2.46, p = 0.01). Extranodal extension, number of tumor positive nodes and pelvic involvement in node positive (pN+) cases were associated with worse 5-year cancer specific survival. CONCLUSIONS Despite less surgery being performed on regional nodes, 5-year cancer specific survival has improved in patients with cN0 disease. The number of tumor positive nodes, extranodal extension and pelvic involvement were highly associated with worse cancer specific survival in patients with pN+ disease. In this group other treatment strategies are needed as no improvement was observed.
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Affiliation(s)
| | - Niels M Graafland
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wim Meinhardt
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hester H van Boven
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Renato A Valdés Olmos
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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de Bruijn RE, Heideman DAM, Kenter GG, van Beurden M, van Tinteren H, Horenblas S. Patients with penile cancer and the risk of (pre)malignant cervical lesions in female partners: a retrospective cohort analysis. BJU Int 2013; 112:905-8. [PMID: 23905914 DOI: 10.1111/bju.12237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine if female partners of patients with penile cancer have more cervical lesions and neoplasia than would be expected from population-based data. PATIENTS AND METHODS We included all consecutive patients with primary penile carcinoma in the period 2004-2010. Results of Dutch cervical cancer screening were used to consider (pre)malignant cervical lesions in female partners of patients with penile cancer. RESULTS In all, 206 women were included. Gynaecological information was available in 195 women: Papanicolaou test (PAP) smears were normal were in 129 partners, 10 smears were abnormal (5.1%, 95% confidence interval 2.5-9.2). PAP2 was found in five, PAP3a in two, PAP3b in two women and PAP4 in one woman. Colposcopy in two women with PAP3b showed cervical intraepithelial neoplasia grade 3 in both. This prevalence was not different from baseline results in the general Dutch population. CONCLUSION Female partners of patients with penile cancer did not show more premalignant cervical lesions than in the general population.
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Colón-López V, Ortiz AP, Soto-Salgado M, Torres-Cintrón M, Pettaway CA, Puras-Báez A, Martínez-Ferrer M, Suárez E. Penile cancer disparities in Puerto Rican men as compared to the United States population. Int Braz J Urol 2012; 38:728-38. [PMID: 23302411 PMCID: PMC3703478 DOI: 10.1590/1677-553820133806728] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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] [Accepted: 08/01/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE This study compares incidence and mortality of penile cancer in Puerto Rico (PR) with other racial/ethnic groups in the United States (US) and evaluates the extent in which socioeconomic position index (SEP) or its components influence incidence and mortality in PR. MATERIALS AND METHODS Age-standardized rates were calculated for incidence and mortality based on data from the PR Cancer Registry and the US National Cancer Institute's Surveillance, Epidemiology and End Results program, using the direct method. RESULTS PR men had approximately 3-fold higher incidence of penile cancer as compared to non-Hispanic white (Standardized rate ratio [SRR]: 3.33; 95%CI=2.80-3.95). A higher incidence of penile cancer was also reported in PR men as compared to non-Hispanic blacks and Hispanics men. Mortality from penile cancer was also higher for PR men as compared to all other ethnic/racial groups. PR men in the lowest SEP index had 70% higher incidence of penile cancer as compared with those PR men in the highest SEP index. However, the association was marginally significant (SRR: 1.70; 95%CI=0.97, 2.87). Only low educational attainment was statistically associated with higher penile cancer incidence (SRR: 2.18; 95%CI=1.42-3.29). CONCLUSIONS Although penile cancer is relatively uncommon, our results support significant disparities in the incidence and mortality rates among men in PR. Low educational attainment might influence the high incidence of penile cancer among PR men. Further studies are strongly recommended to explore these disparities.
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Affiliation(s)
- Vivian Colón-López
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, Puerto Rico
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Abstract
BACKGROUND Verrucous carcinoma of the skin and mucosa is an uncommon type of well-differentiated squamous cell carcinoma. When it is present in the genitoanal region the term used is Buschke-Lowenstein tumor. The human papillomavirus seems to be implicated in its aetiology. Treatment is controversial. Topical chemotherapy, radiotherapy, immunotherapy and radical surgery have been employed. MAIN OBSERVATIONS We report a rapidly progressing penile verrucous carcinoma which was treated sucessfuly with conservative surgery and CO2 laser. CONCLUSION Treatment with CO2 laser in combination with conservative surgery may be a therapeutic option in Buschke-Lowenstein tumor.
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Affiliation(s)
- Jose M Martin
- Department of Dermatology, Hospital Clinico Universitario Valencia, Spain
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