Population-based assessment of the number of lymph nodes removed in the treatment of penile squamous cell carcinoma.
OBJECTIVE
To evaluate the number of lymph nodes (LNs) removed, as a performance measure of lymph node dissection (LND), in a population-based database.


METHODS
Data from the Surveillance, Epidemiology, and End Results database (1988-2009) were used to identify 393 patients who underwent regional LND for penile cancer. The study cohort was divided into two groups: limited LND (<8 LNs removed) and extensive LND (≥8 LNs removed). Logistic regression analyses were performed to assess factors associated with extensive LND. Log-rank tests were used to evaluate the associations between LN evaluation and survival outcomes.


RESULTS
The median number of removed LNs was 15, and 28% of patients underwent limited LND. The prevalence of extensive LND decreased gradually with increasing age: from 81% in men younger than 50 years to 65% in men aged 70 years or older. In multivariate analysis, only age retained an independent association with extensive LND (odds ratio = 0.98, p = 0.01). Log-rank test showed better cause-specific survival in patients receiving extensive LND (p = 0.006). The difference in survival was statistically significant in the subgroup of node-positive penile cancer patients (p = 0.01).


CONCLUSIONS
An inadequate number of LN retrieval was observed in a considerable proportion of penile cancer patients, especially in the elderly population.
Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, PR China.
Yao
Y
Zhu
Cheng-Yuan
CY
Gu
Ding-Wei
DW
Ye
D000367:Age Factors; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010412:Penile Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D012044:Regression Analysis; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome