title: Risk stratification in penile carcinoma: 25-year experience with surgical inguinal lymph node staging.
abstract: OBJECTIVE
  In penile carcinoma, the most reliable staging method for lymph node involvement remains radical dissection with its associated high morbidity. However, the patient's prognosis is closely associated with lymph node status, and radical dissection is potentially curative. We report our experience with surgical lymph node staging and evaluate which group of patients could be assigned to a wait-and-see strategy or dynamic sentinel node biopsy and which group should undergo groin dissection.
  
  
  METHODS
  From 1979 to 2004, 56 consecutive patients with penile cancer underwent surgical inguinal lymph node staging. On the basis of the histopathologic results, we defined risk stratification into low, high, and intermediate-risk groups according to the clinical examination findings, stage, and grade.
  
  
  RESULTS
  Tumor stage (P = 0.019) and tumor grade (P <0.001) correlated significantly with lymph node status. Stratification into low (pT1G1, pT1G2), high (all G3 tumors), and intermediate-risk (all others) groups found 7.7% of low-risk patients with metastases. In the intermediate and high-risk groups, 28.6% and 75.0% had nodal metastases, respectively. Correlation with nodal involvement according to risk group was R2 = 0.608 (P <0.001).
  
  
  CONCLUSIONS
  Risk stratification might enable a modified staging strategy for lymph node status according to stage, grade, and clinical examination findings. Highly motivated low-risk patients could be included in a surveillance program; however, high-risk patients should undergo bilateral inguinal dissection. Dynamic sentinel lymph node biopsy might be encouraged for intermediate-risk patients in the future.
authors.affiliation: Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany. Hungerhuber@gmx.de
authors.forename: Edwin
authors.initials: E
authors.lastname: Hungerhuber
authors.forename: Boris
authors.initials: B
authors.lastname: Schlenker
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
authors.forename: Dominic
authors.initials: D
authors.lastname: Frimberger
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Rothenberger
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Peter
authors.initials: P
authors.lastname: Schneede
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000473:pathology* / Q000601:surgery*; D018570:Risk Assessment; D013997:Time Factors