Risk Factors Of Lymph Node Metastases In Penile Squamous Cell Cancer

Purpose: To determine if clinical and histological factors of the primary penile tumor can stratify the risk of inguinal node metastases.Materials and Methods:Clinical records of 46 patients with squamous cancer of the penis which underwent resection of primary lesion and either inguinal lymph node dissection or were observed for signs of recurrence were review. Parameters examined included diameter of tumor, the site and growth pattern of primary lesion, pathological tumor stage, histological grade, number and size of inguinal lymph nodes, course of disease, and age of patients. We evaluated the relationship between each factor and the presence of metastasis. Logistic stepwise regression was used for multivariate analysis.Results: Of the 46 patients, inguinal lymph nodal metastases were present in 17 patients (37%), and bilateral metastases were occurred in 11 patients. Pathological tumor stage, histological grade, growth pattern of primary lesion and size of inguinal lymph nodes are more likely to be associated with nodal metastases ( odds ratio >1, regression coefficient >0). Involvement of lymph nodes was found in 16 of 29 (55.1%) patients with pT2 or greater tumor, but in only 1 of 16 with pTa/Tl tumor (p=0.0064). The incidence of nodal metastases was 2 of 10 (20%) patients with Gl, 9 of 28 (32.1%) with G2 and 6 of 8 (75%) with G3 tumor (p=0.0183). Only 2 of 12 (16.7%) with papillary carcinoma compared with 15 of 34 (44.1%) patients with vertical growth or ulcer tumor (p=0.0254). Nodal metastases were present in 14 of 22(63.6%) patients with inguinal nodes larger than 1.5 cm, but in only 3 of 24 (12.5%) without inguinal nodes larger than 1.5 cm. Pathological tumor stage and size of inguinal lymph nodes exhibited stronger associations with lymph node metastasis than others.Conclusion: 1. Pathological tumor stage, histological grade, growthpattern of primary lesion and size of inguinal lymph nodes were risk factors for inguinal lymph nodal metastases. The evaluation on the risk of the development of node metastases could be made base on these four factors.2. As lymph nodal metastases often occur on bilateral, bilateral lymphadenectomy is recommended.