DEOXYRIBONUCLEIC-ACID FLOW-CYTOMETRY AND TRADITIONAL PATHOLOGICAL VARIABLES IN INVASIVE PENILE CARCINOMA - ASSESSMENT OF PROGNOSTIC-SIGNIFICANCE

Objectives. The identification of reliable prognostic factors to guide the selection of patients at high risk of harboring subclinical metas tases in penile cancer is important. We evaluated traditional patholog ic variables and deoxyribonucleic acid (DNA) flow cytometry to determi ne the prognostic significance of these variables for the subsequent d evelopment of lymph node metastases. Methods. Clinical data and pathol ogic specimens were retrospectively reviewed from patients treated sur gically at university-affiliate hospitals from 1958 to 1987. Pathologi c analysis (grade, depth of invasion, and pathologic stage) and DNA fl ow cytometry were performed on specimens from 46 patients with invasiv e penile carcinoma and complete medical records. Pathologic variables were compared with DNA flow cytometry results in patients who never de veloped lymph node metastasis (32 patients, median follow-up 121 month s) and in those who presented with or developed proved lymph node meta stases (14 patients, median follow-up 18 months). Results. The distrib utions of diploid and nondiploid tumors were similar in patients with or without lymph node metastasis. In addition, there was no significan t difference in the grade distributions of tumors with respect to lymp h node status. Patients with positive nodes more commonly had tumors t hat invaded greater than 0.5 cm or that exhibited pathologic Stage T2 or greater (deep invasion). All 14 patients who presented with or subs equently developed metastasis had deep primary tumors. Thirteen of 36 patients with clinically negative nodes had superficially invasive tum ors (pathologic Stage T1 and depth of invasion 0.5 cm or less), and no ne developed metastasis (median follow-up 124 months [range 58 to 240] ). Tumor grade was significantly related to the likelihood of deep inv asion but was not an independent prognostic factor for metastasis. Con clusions. DNA flow cytometry does not add prognostic information to th at obtained by pathologic assessment in patients with invasive penile carcinoma. The presence of pathologic Stage T2 or greater or depth of invasion greater than 0.5 cm defines a group of patients at high risk of inguinal node metastasis. A novel finding was that patients with mi nimally invasive lesions (0.5 cm or less) and no evidence of corporal invasion (pathologic Stage T1) have little risk of inguinal node metas tasis. Close observation of reliable patients meeting these criteria m ay be a safe alternative to prophylactic lymphadenectomy. (C) 1998, El sevier Science Inc. All rights reserved.