Fatores De Prognóstico No Cancro Do Pénis - Devemos Evitar O Estadiamento Dos Gânglios Linfáticos Inguinais ?

Abstract

Background: Penile cancer (PC) is a rare neoplasm, mostly in developed countries. Surgery is the only curative treatment, which mostly depends on the disease's stage. The great predisposition to lymph node involvement often implies inguinal and/or pelvic lymphadenectomy. Objective: To evaluate the main prognostic factors of patients with PC undergoing surgery. Design, Setting, and Participants: Retrospective analysis of 65 patients with PC treated at a tertiary centre over the last 15 years (2004-2018). Outcome Measurements and Statistical Analysis: The statistical analysis evaluated prognostic factors of overall survival. Results and limitation: The median age of the patients was 61 years (P25-75, 53-75,5). Partial amputation was performed in 52 (80,0%) patients. Almost half (48%) of the patients were diagnosed at an advanced local stage pT3/4. 38 (58%) patients underwent inguinal lymphadenectomy, and 25 (66%) were negative for lymph node invasion. Median survival was not reached. However, overall survival was 80% at a median follow-up of 31 months. In the multivariate analysis, the main factors of poor prognosis were nodal staging (pN) (p = 0.008) and perineural invasion (p = 0.023). The presence of lymph node metastasis and perineural invasion in the primary tumor increased the risk of death by 29 (hazard ratio 29.0, 95% confidence interval 2.4-354.2) and 13 (hazard ratio 12.7, 95% confidence interval 1.4-112.0) times, respectively. Conclusions: Late diagnosis of PC is still a matter of concern. This factor may have a negative impact on overall PC survival, as nodal invasion correlates with survival. Despite the high number of negative inguinal lymphadenectomy, we continue to advocate aggressive surgical treatment of this disease due to the poor prognosis associated with lymph node metastasis. Patient summary: Patients with inguinal lymph node metastasis and perineural invasion were found to have poor prognosis in multivariate analysis.