Prospective validation of association of local tumor stage and grade as predictive factor for occult lymph node micrometastases in patients with penile carcinoma and clinically negative inguinal lymph nodes

Purpose: We prospectively validated the association of local tumor stage an d grade as a predictive factor for occult lymph node micrometastasis in pat ients with penile carcinoma and clinically negative lymph nodes. Materials and Methods: In a retrospective study of 66 patients we demonstra ted the predictive value of the association of local tumor stage and grade for occult micrometastasis? identifying 3 risk groups. A therapy strategy w as designed according to these risk groups. A total of 37 consecutive patie nts were included in a prospective study in which the same criteria for ris k group allocation and the same therapeutic recommendations were used as in the retrospective study. Results: In the prospective study we noted positive lymph nodes in 11% of s tage T1, 63% of stages T2-3, 15% of grade 1, 67% of grade 2 and 75% of grad e 3 cases. The incidence of positive nodes was 0% in the low, 83.3% in the high and 33.3% in the intermediate risk group. These rates were similar to those in the retrospective study with no significant difference. Conclusions: The predictive value of the association of local tumor stage a nd grade for occult lymph node micrometastasis was validated in a prospecti ve study. This factor allows the differentiation of 3 risk groups of patien ts with high reliability in the low and high risk groups. However, other pr ognostic factors are needed in the intermediate risk group to improve the p rediction of lymph node involvement.