OUTCOMES OF INITIAL SURVEILLANCE OF INVASIVE SQUAMOUS-CELL CARCINOMA OF THE PENIS AND NEGATIVE NODES

Purpose: We determined factors predictive of inguinal nodal relapse in patients with stages T1 to 3N0M0 squamous cell penile cancer treated initially with surveillance of inguinal nodes. Materials and Methods: Between 1980 and 1994, in 42 patients with stages T1 to 3N0M0 squamous cell penile cancer of 60 with invasive disease seen at our center the inguinal nodes were surveyed after definitive treatment of the primar y tumor. Clinical inguinal nodal recurrences were treated with inguina l lymphadenectomy. Results: A total of 26 patients (62%) had inguinal nodal recurrences during followup, with 50% occurring within 1.4 years and 75% within 2.8 years of resection of the primary tumor. The only factor predicting nodal relapse was grade of the primary tumor at init ial treatment. Patients with grade 1 tumors had a 45% long-term actuar ial relapse-free survival rate. All other groups had a 100% actuarial nodal relapse rate. Of the patients 10% had metastatic disease without nodal recurrence. Conclusions: Invasive penile cancer may be associat ed with inguinal lymph node and hematogenous metastasis. A strong case for prophylactic bilateral inguinal lymphadenectomy can be made in pa tients with primary tumors other than grade 1, since surveillance of t hese patients will not-spare them eventual lymphadenectomy and may pot entially compromise survival by delaying surgery. Patients with grade 1 tumors may be offered either careful surveillance or prophylactic bi lateral inguinal lymphadenectomy depending on the clinical circumstanc es and patient preference.