title: Extensive inguinal lymphadenectomy improves overall 5-year survival in penile cancer patients: results from the Surveillance, Epidemiology, and End Results program.
abstract: BACKGROUND
  European Urological Association guidelines recommend potentially curative inguinal lymphadenectomy for certain cases of penile cancer such as grade 3 and pT2-4 lesions, among others. Anecdotally, the authors have noticed that few patients undergo inguinal lymphadenectomy. Therefore, they assessed the frequency of inguinal lymphadenectomy and the impact of dissection extent on survival using the Surveillance, Epidemiology, and End Results (SEER) database.
  
  
  METHODS
  The authors queried 17 SEER registries from 1988 through 2005 for grade 3 and pT2-4 penile cancer patients without distant metastases. Univariate and multivariate analyses examined predictors of inguinal lymphadenectomy. Kaplan-Meier and Cox regression analyses assessed overall 5-year survival across patient- and disease-related characteristics for patients receiving inguinal lymphadenectomy involving <8 or > or = 8 lymph nodes, the latter a surrogate for extent of dissection based on other malignancies.
  
  
  RESULTS
  Of 593 patients enrolled, only 26.5% received inguinal lymphadenectomy. In addition to grade 3 (P = .031) and pT2-4 disease (P = .004), age <65 years (P < .001) and marital status (P = .002) were significantly associated with receiving lymph node dissection. Increased overall 5-year survival (hazard ratio, 0.54; 95% confidence interval, 0.36-0.79) was observed in patients of all ages who received lymphadenectomy involving > or = 8 lymph nodes.
  
  
  CONCLUSIONS
  A significant number of penile cancer patients at risk for metastases have not received potentially curative inguinal lymphadenectomy. Patients receiving inguinal lymphadenectomy involving > or = 8 lymph nodes experienced improved overall 5-year survival. Guidelines should not only be given more emphasis, but possibly be updated to reflect the benefit of extensive lymph node dissection in high-risk penile cancer patients.
authors.affiliation: Department of Urology, School of Medicine, Emory University, Atlanta, GA 30322, USA.
authors.forename: Timothy V
authors.initials: TV
authors.lastname: Johnson
authors.forename: Wayland
authors.initials: W
authors.lastname: Hsiao
authors.forename: Keith A
authors.initials: KA
authors.lastname: Delman
authors.forename: Ashesh B
authors.initials: AB
authors.lastname: Jani
authors.forename: Otis W
authors.initials: OW
authors.lastname: Brawley
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
mesh_terms: D000368:Aged; D006801:Humans; D008197:Lymph Node Excision / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D010412:Penile Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant; D018426:SEER Program