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A RISK INDEX BASED ON PENILE CARCINOMA pT STAGE AND GRADE FOR REGIONAL LYMPHATIC SPREAD

The aim of this study was to investigate the predictive value of a risk index (RI) based on tumor pT stage and grade on the prognosis for inguinal lymphactic metastasis. We included 53 patients bearing schamous cell carcinoma of the penis (SCCP) treated by penectomy at the Hospital das Clínicas da FMRP-USP from 1978 to 1995. Age range varied from 32 to 97 years. Tumor grading was determined according to Broders method and staging by 1999 TNM system. RI was calculated by the sum of pT stage and grade (RI = pT+G). Bilateral inguinal lymphdenectomy was carried out within 6 weeks the penectomy in 14 patients cN+ at the presentation. The remaining 36 cases were kept under surveillance. In 9 of these patients required a delayed regional lymphadenectomy due to nodal relapse (median follow-up: 9 months). Proportions of pN0 patients according to RI were: 92% - 2, 80% - 3 and 0% - 6. The proportion of pN+ patients with a pooled RI of 4, 5 and 6 was significantly higher than that seen in pooled cases with lower RI (p = 0,004). From 36 patients initially cN0, 27 were RI 2 or 3 ( 5 of them progressed later on to pN+ , 19%) and 9 were RI ³ 4 (3 of them had progression to lymphatic spread, 33%). But, the difference observed in cN0 patients was not significant (p = 0,3). In conclusion, patients with RI ³ 4 were at higher risk of nodal spread when the overall sample was at stake, but this cutoff level for RI had no predictive value for the patients that were initially cN0.

penile cancer; prognostic factors; lymph nodes


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