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Lymph Node Management in Penile Cancer

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Urologic Oncology

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Abstract

Lymph node metastases are frequently found in patients with penile cancer even in early stages. Since prognosis of patients with lymph node recurrence is extremely poor, sufficient initial lymph node management is the key for the survival of penile cancer patients. Invasive lymph node staging (dynamic sentinel node biopsy or modified inguinal lymph node dissection) is recommended in patients with nonpalpable lymph nodes with pT1G2 tumors or higher stages. In case of palpable inguinal lymph nodes, a radical inguinal lymph node dissection followed by adjuvant chemotherapy is indicated after histological verification of metastases. Patients with fixed inguinal or recurrent lymph node metastases should undergo a neoadjuvant chemotherapy followed by salvage lymph node dissection.

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References

  • Allen B, Campbell I, Desai S, Dray M, Scarlet J. Pilot study comparing the accuracy of lymphoscintigraphy sentinel lymph node localisation with axillary node dissection in women with operable breast cancer. N Z Med J. 2001;114:233–6.

    CAS  PubMed  Google Scholar 

  • Berdjis N, Meye A, Nippgen J, Dittert D, Hakenberg O, Baretton GB, Wirth MP. Expression of Ki-67 in squamous cell carcinoma of the penis. BJU Int. 2005;96:146–8.

    Article  CAS  Google Scholar 

  • Bevan-Thomas R, Slaton JW, Pettaway CA. Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol. 2002;167:1638–42.

    Article  Google Scholar 

  • Bezerra AL, Lopes A, Santiago GH, Ribeiro KC, Latorre MR, Villa LL. Human papillomavirus as a prognostic factor in carcinoma of the penis: analysis of 82 patients treated with amputation and bilateral lymphadenectomy. Cancer. 2001;91:2315–21.

    Article  CAS  Google Scholar 

  • Bouchot O, Rigaud J, Maillet F, Hetet JF, Karam G. Morbidity of inguinal lymphadenectomy for invasive penile carcinoma. Eur Urol. 2004;45:761–5; discussion 765–766.

    Article  Google Scholar 

  • Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977;39:456–66.

    Article  CAS  Google Scholar 

  • Catalona WJ. Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol. 1988;140:306–10.

    Article  CAS  Google Scholar 

  • Daseler EH, Anson BJ, Reimann AF. Radical excision of the inguinal and iliac lymph glands; a study based upon 450 anatomical dissections and upon supportive clinical observations. Surg Gynecol Obstet. 1948;87:679–94.

    CAS  PubMed  Google Scholar 

  • Ficarra V, Galfano A. Should the dynamic sentinel node biopsy (DSNB) be considered the gold standard in the evaluation of lymph node status in patients with penile carcinoma? Eur Urol. 2007;52:17–9; discussion 20–11.

    Article  Google Scholar 

  • Ficarra V, Zattoni F, Cunico SC, Galetti TP, Luciani L, Fandella A, Guazzieri S, Maruzzi D, Sava T, Siracusano S, Pilloni S, Tasca A, Martignoni G, Gardiman M, Tardanico R, Zambolin T, Cisternino A, Artibani W. Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis: Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer data base data. Cancer. 2005;103:2507–16.

    Article  Google Scholar 

  • Ficarra V, Zattoni F, Artibani W, Fandella A, Martignoni G, Novara G, Galetti TP, Zambolin T, Kattan MW. Nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. J Urol. 2006;175:1700–4; discussion 1704–1705.

    Article  Google Scholar 

  • Gkegkes ID, Minis EE, Iavazzo C. Robotic-assisted inguinal lymphadenectomy: a systematic review. J Robot Surg. 2019;13(1):1–8.

    Article  Google Scholar 

  • Guimaraes GC, Leal ML, Campos RS, Zequi Sde C, da Fonseca FP, da Cunha IW, Soares FA, Lopes A. Do proliferating cell nuclear antigen and MIB-1/Ki-67 have prognostic value in penile squamous cell carcinoma? Urology. 2007;70:137–42.

    Article  Google Scholar 

  • Hakenberg OW, Nippgen JB, Froehner M, Zastrow S, Wirth MP. Cisplatin, methotrexate and bleomycin for treating advanced penile carcinoma. BJU Int. 2006;98:1225–7.

    Article  CAS  Google Scholar 

  • Hakenberg OW, Compérat EM, Minhas S, Necchi A, Protzel C, Watkin N. EAU guidelines on penile cancer: 2014 update. Eur Urol. 2015;67(1):142–50.

    Article  Google Scholar 

  • Hegarty PK, Kayes O, Freeman A, Christopher N, Ralph DJ, Minhas S. A prospective study of 100 cases of penile cancer managed according to European Association of Urology guidelines. BJU Int. 2006;98:526–31.

    Article  Google Scholar 

  • Horenblas S. Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection. BJU Int. 2001a;88:473–83.

    Article  CAS  Google Scholar 

  • Horenblas S. Lymphadenectomy for squamous cell carcinoma of the penis. Part 1: diagnosis of lymph node metastasis. BJU Int. 2001b;88:467–72.

    Article  CAS  Google Scholar 

  • Horenblas S, Jansen L, Meinhardt W, Hoefnagel CA, de Jong D, Nieweg OE. Detection of occult metastasis in squamous cell carcinoma of the penis using a dynamic sentinel node procedure. J Urol. 2000;163:100–4.

    Article  CAS  Google Scholar 

  • Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43–66.

    Article  Google Scholar 

  • Kayes O, Ahmed HU, Arya M, Minhas S. Molecular and genetic pathways in penile cancer. Lancet Oncol. 2007;8:420–9.

    Article  CAS  Google Scholar 

  • Kroon BK, Horenblas S, Estourgie SH, Lont AP, Valdes Olmos RA, Nieweg OE. How to avoid false-negative dynamic sentinel node procedures in penile carcinoma. J Urol. 2004;171:2191–4.

    Article  CAS  Google Scholar 

  • Kroon BK, Horenblas S, Lont AP, Tanis PJ, Gallee MP, Nieweg OE. Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol. 2005a;173:816–9.

    Article  CAS  Google Scholar 

  • Kroon BK, Horenblas S, Deurloo EE, Nieweg OE, Teertstra HJ. Ultrasonography-guided fine-needle aspiration cytology before sentinel node biopsy in patients with penile carcinoma. BJU Int. 2005b;95:517–21.

    Article  Google Scholar 

  • Leijte JA, Horenblas S. Shortcomings of the current TNM classification for penile carcinoma: time for a change? World J Urol. 2009;27(2):151–4.

    Google Scholar 

  • Leijte JA, Kroon BK, Valdes Olmos RA, Nieweg OE, Horenblas S. Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol. 2007a;52:170–7.

    Article  Google Scholar 

  • Leijte JA, Olmos RA, Nieweg OE, Horenblas S. Anatomical mapping of lymphatic drainage in penile carcinoma with SPECT-CT: implications for the extent of inguinal lymph node dissection. Eur Urol. 2008a.

    Google Scholar 

  • Leijte JA, Kirrander P, Antonini N, Windahl T, Horenblas S. Recurrence patterns of squamous cell carcinoma of the penis: recommendations for follow-up based on a two-centre analysis of 700 patients. Eur Urol. 2008b;54:161–8.

    Article  Google Scholar 

  • Lont AP, Horenblas S, Tanis PJ, Gallee MP, van Tinteren H, Nieweg OE. Management of clinically node negative penile carcinoma: improved survival after the introduction of dynamic sentinel node biopsy. J Urol. 2003;170:783–6.

    Article  CAS  Google Scholar 

  • Lont AP, Kroon BK, Horenblas S, Gallee MP, Berkhof J, Meijer CJ, Snijders PJ. Presence of high-risk human papillomavirus DNA in penile carcinoma predicts favorable outcome in survival. Int J Cancer. 2006;119:1078–81.

    Article  CAS  Google Scholar 

  • Lont AP, Kroon BK, Gallee MP, van Tinteren H, Moonen LM, Horenblas S. Pelvic lymph node dissection for penile carcinoma: extent of inguinal lymph node involvement as an indicator for pelvic lymph node involvement and survival. J Urol. 2007;177:947–52; discussion 952.

    Article  Google Scholar 

  • Lopes A, Hidalgo GS, Kowalski LP, Torloni H, Rossi BM, Fonseca FP. Prognostic factors in carcinoma of the penis: multivariate analysis of 145 patients treated with amputation and lymphadenectomy. J Urol. 1996a;156:1637–42.

    Article  CAS  Google Scholar 

  • Lopes A, Rossi BM, Fonseca FP, Morini S. Unreliability of modified inguinal lymphadenectomy for clinical staging of penile carcinoma. Cancer. 1996b;77:2099–102.

    Article  CAS  Google Scholar 

  • Lopes A, Bezerra AL, Pinto CA, Serrano SV, de Mell OC, Villa LL. p53 as a new prognostic factor for lymph node metastasis in penile carcinoma: analysis of 82 patients treated with amputation and bilateral lymphadenectomy. J Urol. 2002;168:81–6.

    Article  Google Scholar 

  • Lughezzani G, Catanzaro M, Torelli T, Piva L, Biasoni D, Stagni S, Crestani A, Guttilla A, Raggi D, Giannatempo P, Necchi A, Pizzocaro G, Colecchia M, Salvioni R, Nicolai N. The relationship between characteristics of inguinal lymph nodes and pelvic lymph node involvement in penile squamous cell carcinoma: a single institution experience. J Urol. 2014;191(4):977–82.

    Google Scholar 

  • Martins AC, Faria SM, Cologna AJ, Suaid HJ, Tucci S Jr. Immunoexpression of p53 protein and proliferating cell nuclear antigen in penile carcinoma. J Urol. 2002;167:89–92; discussion 92-83.

    Article  CAS  Google Scholar 

  • Naumann CM, Filippow N, Seif C, van der Horst C, Roelver L, Braun PM, Juenemann KP, Portillo FJ. Penile carcinoma (pT1 G2): surveillance or inguinal lymph node dissection? Onkologie. 2005;28:135–8.

    PubMed  Google Scholar 

  • Perdona S, Autorino R, De Sio M, Di Lorenzo G, Gallo L, Damiano R, D’Armiento M, Gallo A. Dynamic sentinel node biopsy in clinically node-negative penile cancer versus radical inguinal lymphadenectomy: a comparative study. Urology. 2005;66:1282–6.

    Article  Google Scholar 

  • Pizzocaro G, Nicolai N, Milani A. Taxanes in combination with cisplatin and fluorouracil for advanced penile cancer: preliminary results. Eur Urol. 2008.

    Google Scholar 

  • Protzel C, Knoedel J, Wolf E, Kleist B, Poetsch M, Giebel J. Prognostic parameters of penis carcinoma. Urologe A. 2007a;46:1162.

    Article  CAS  Google Scholar 

  • Protzel C, Knoedel J, Zimmermann U, Woenckhaus C, Poetsch M, Giebel J. Expression of proliferation marker Ki67 correlates to occurrence of metastasis and prognosis, histological subtypes and HPV DNA detection in penile carcinomas. Histol Histopathol. 2007b;22:1197–204.

    CAS  PubMed  Google Scholar 

  • Protzel C, Kakies C, Kleist B, Poetsch M, Giebel J. Down-regulation of the metastasis suppressor protein KAI1/CD82 correlates with occurrence of metastasis, prognosis and presence of HPV DNA in human penile squamous cell carcinoma. Virchows Arch. 2008;452:369–75.

    Article  CAS  Google Scholar 

  • Protzel C, Alcaraz A, Horenblas S, Pizzocaro G, Zlotta A, Hakenberg OW. Lymphadenectomy in the surgical management of penile cancer. Eur Urol. 2009;55(5):1075–88.

    Article  Google Scholar 

  • Ravi R. Morbidity following groin dissection for penile carcinoma. Br J Urol. 1993;72:941–5.

    Article  CAS  Google Scholar 

  • Saisorn I, Lawrentschuk N, Leewansangtong S, Bolton DM. Fine-needle aspiration cytology predicts inguinal lymph node metastasis without antibiotic pretreatment in penile carcinoma. BJU Int. 2006;97:1225–8.

    Article  Google Scholar 

  • Scher B, Seitz M, Reiser M, Hungerhuber E, Hahn K, Tiling R, Herzog P, Schneede P, Dresel S. 18F-FDG PET/CT for staging of penile cancer. J Nucl Med. 2005;46:1460–5.

    PubMed  Google Scholar 

  • Scher B, Seitz M, Albinger W, Reiser M, Schlenker B, Stief C, Mueller-Lisse U, Dresel S. Value of PET and PET/CT in the diagnostics of prostate and penile cancer. Recent Results Cancer Res. 2008;170:159–79.

    Article  CAS  Google Scholar 

  • Singh AK, Gonzalez-Torrez P, Kaewlai R, Tabatabaei S, Harisinghani MG. Imaging of penile neoplasm. Semin Ultrasound CT MR. 2007;28:287–96.

    Article  Google Scholar 

  • Slaton JW, Morgenstern N, Levy DA, Santos MW Jr, Tamboli P, Ro JY, Ayala AG, Pettaway CA. Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol. 2001;165:1138–42.

    Article  CAS  Google Scholar 

  • Sotelo R, Sanchez-Salas R, Carmona O, Garcia A, Mariano M, Neiva G, Trujillo G, Novoa J, Cornejo F, Finelli A. Endoscopic lymphadenectomy for penile carcinoma. J Endourol. 2007;21:364–7; discussion 367

    Article  Google Scholar 

  • Spiess PE, Hernandez MS, Pettaway CA. Contemporary inguinal lymph node dissection: minimizing complications. World J Urol. 2009;27(2):205–12.

    Google Scholar 

  • Statius Muller MG, van Leeuwen PA, Borgstein PJ, Pijpers R, Meijer S. The sentinel node procedure in cutaneous melanoma: an overview of 6 years’ experience. Eur J Nucl Med. 1999;26:S20–5.

    Article  CAS  Google Scholar 

  • Tanis PJ, Lont AP, Meinhardt W, Olmos RA, Nieweg OE, Horenblas S. Dynamic sentinel node biopsy for penile cancer: reliability of a staging technique. J Urol. 2002;168:76–80.

    Article  CAS  Google Scholar 

  • Theodorescu D, Russo P, Zhang ZF, Morash C, Fair WR. Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol. 1996;155:1626–31.

    Article  CAS  Google Scholar 

  • Tobias-Machado M, Tavares A, Ornellas AA, Molina WR Jr, Juliano RV, Wroclawski ER. Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol. 2007;177:953–7; discussion 958.

    Article  Google Scholar 

  • Tobias-Machado M, Tavares A, Silva MN, Molina WR Jr, Forseto PH, Juliano RV, Wroclawski ER. Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol. 2008;22(8):1687–91.

    Google Scholar 

  • Wespes E, Simon J, Schulman CC. Cabanas approach: is sentinel node biopsy reliable for staging penile carcinoma? Urology. 1986;28:278–9.

    Article  CAS  Google Scholar 

  • Zargar-Shoshtari K, Djajadiningrat R, Sharma P, Catanzaro M, Zhu Y, Nicolai N, Horenblas S, Spiess PE. Establishing criteria for bilateral pelvic lymph node dissection in the management of penile cancer: lesson learned from an international study. J Urol. 2015;194(3):696–701.

    Article  Google Scholar 

  • Zargar-Shoshtari K, Sharma P, Djajadiningrat R, Catanzaro M, Ye DW, Zhu Y, Nicolai N, Horenblas S, Spiess PE. Extent of pelvic lymph node dissection in penile cancer may impact survival. World J Urol. 2016;34(3):353–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Deptartment of Urology, Helios-Kliniken Schwerin, Schwerin, Germany

    Chris Protzel

  2. Deptartment of Urology, University of Rostock, Rostock, Germany

    Oliver W. Hakenberg

  3. Deptartment of Genitourinary Oncology and Tumor Biology, Moffit Cancer Center, Tampa, Fl, USA

    Philippe E. Spiess

Authors
  1. Chris Protzel
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  2. Oliver W. Hakenberg
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  3. Philippe E. Spiess
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Corresponding author

Correspondence to Chris Protzel .

Editor information

Editors and Affiliations

  1. Urologie, Univ Lübeck, Lübeck, Schleswig-Holstein, Germany

    Axel Merseburger

  2. Dept. of Urology, University of Regensburg St. Josef Medical Centre, Regensburg, Germany

    Maximilian Burger

Section Editor information

  1. Department of Urology, Helios Kliniken Schwerin, Schwerin, Germany

    Chris Protzel

  2. Department of Urology, Urologic Oncology, Robot-assisted and Specialized Urologic Surgery, University Hospital Cologne, Köln, Germany

    Axel Heidenreich

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Protzel, C., Hakenberg, O.W., Spiess, P.E. (2019). Lymph Node Management in Penile Cancer. In: Merseburger, A., Burger, M. (eds) Urologic Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-42603-7_36-1

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  • DOI: https://doi.org/10.1007/978-3-319-42603-7_36-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42603-7

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