PROGNOSTIC FACTORS IN CARCINOMA OF THE PENIS - MULTIVARIATE-ANALYSIS OF 145 PATIENTS TREATED WITH AMPUTATION AND LYMPHADENECTOMY

Purpose: The major issue in penile cancer is deciding who should or sh ould not undergo lymph node dissection. Clinical and invasive methods are not reliable for staging. Clinical and pathological factors involv ed in lymph node metastases and prognosis were evaluated in 145 patien ts with penile carcinoma staged according to the 1978 TNM system, and treated with amputation and lymphadenectomy. Materials and Methods: Cl inical factors studied were patient age, race, disease evolution time, symptoms, and clinical T and N stages. Pathological factors of the pr imary tumor considered were tumor thickness, histological grade, lymph atic and venous embolization, infiltration of the corpora cavernosa, c orpus spongiosum and urethra, mononuclear and eosinophilic infiltrates , and cell alterations suggestive of human papillomavirus. All slides were reviewed by 1 pathologist. The Cox regression hazards method for multifactorial analysis was used. Results: Followup ranged from 0.7 to 453.2 months (mean 85.8, median 32.7). The 5-year disease-free and ov erall survival rates were 45.3 and 54.3%, respectively. Venous and lym phatic embolizations were the main factors affecting significantly the incidence of lymph node metastasis, which were the main risks factors for recurrence and death. Pathologically proved infiltration of the c orpora cavernosa, urethra and adjacent structures, which corresponded to stages T2, T3 and T4 disease, respectively, of the current TNM clas sification, were not significant predictors for incidence of lymph nod e metastasis, disease-free and overall survival or risk factors for re currence and death. Conclusions: Because venous and lymphatic emboliza tions were related to greatest risk of lymph node metastasis, we propo se their evaluation in staging and therapeutic planning of patients wi th infiltrative tumors of the penis.