title: Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis: Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer data base data.
abstract: BACKGROUND
  The objective of the current study was to identify independent clinical and pathologic variables that were predictive of lymph node involvement in patients with squamous cell carcinoma of the penis in a multicenter series with the intent to select patients who were suitable to undergo immediate inguinal lymphadenectomy.
  
  
  METHODS
  Data were analyzed from 175 patients who underwent surgery for penile carcinoma in 11 urologic centers participating in the Gruppo Uro-Oncologico del Nord-Est (Northeast Uro-Oncological Group) Penile Cancer Data Base. Pathologically positive lymph nodes were defined as the presence of histologically confirmed lymph node metastasis in patients who underwent either immediate or delayed inguinal and/or pelvic lymphadenectomy. Patients who had clinically positive lymph nodes with cytologically positive fine-needle aspiration results and who had not undergone lymphadenectomy were censored.
  
  
  RESULTS
  Overall, lymph-node involvement was observed in 71 of 175 patients (40.6%) included in the analyses. After analyzing the whole group of patients, the following variables were identified as independent predictors of pathologic lymph node metastasis: clinical lymph node status, pathologic stage of the primary tumor, venous and lymphatic embolizations, and histologic grade. In the subgroup of patients with clinically negative lymph nodes, tumor thickness, histologic grade, lymphatic and venous embolizations, infiltration of both corpus spongiosum and urethra, and pathologic stage of the primary tumor (according to the 1997 TNM classification system) were predictive of lymph node involvement on univariate analysis. The generated logistic regression model showed that venous and/or lymphatic embolizations and infiltration of the corpus spongiosum and/or urethra were independent predictors of pathologic lymph node metastasis in patients with clinically negative lymph nodes.
  
  
  CONCLUSIONS
  Venous and/or lymphatic embolizations played relevant roles as predictors of pathologic lymph node involvement in patients with penile neoplasia and should be considered important parameters in determining which patients with clinically negative lymph nodes should undergo immediate lymphadenectomy.
authors.affiliation: Department of Urology, University of Verona, Verona, Italy. vincenzo.ficarra@univr.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Filiberto
authors.initials: F
authors.lastname: Zattoni
authors.forename: Sergio Cosciani
authors.initials: SC
authors.lastname: Cunico
authors.forename: Tommaso Prayer
authors.initials: TP
authors.lastname: Galetti
authors.forename: Lucio
authors.initials: L
authors.lastname: Luciani
authors.forename: Andrea
authors.initials: A
authors.lastname: Fandella
authors.forename: Stefano
authors.initials: S
authors.lastname: Guazzieri
authors.forename: Daniele
authors.initials: D
authors.lastname: Maruzzi
authors.forename: Teodoro
authors.initials: T
authors.lastname: Sava
authors.forename: Salvatore
authors.initials: S
authors.lastname: Siracusano
authors.forename: Stefania
authors.initials: S
authors.lastname: Pilloni
authors.forename: Andrea
authors.initials: A
authors.lastname: Tasca
authors.forename: Guido
authors.initials: G
authors.lastname: Martignoni
authors.forename: Marina
authors.initials: M
authors.lastname: Gardiman
authors.forename: Regina
authors.initials: R
authors.lastname: Tardanico
authors.forename: Tiziano
authors.initials: T
authors.lastname: Zambolin
authors.forename: Antonio
authors.initials: A
authors.lastname: Cisternino
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D004621:Embolization, Therapeutic; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000473:pathology / Q000628:therapy*; D011379:Prognosis