title: Is it possible to predict the need of inguinal lymphadenectomy in patients with squamous cell carcinoma of the penis? A clinical and a pathological study.
abstract: OBJECTIVE
  to investigate the role of CD- 44 immunohistochemical expression within tumoural and non-tumoural tissue, aiming to understand if it can help us to predict the need of performing inguinal lymph nodes dissection to complete surgery of the penis.
  
  
  METHODS
  CD44 immunohistochemical expression was investigated in tissue specimens from 39 patients with squamous cell carcinoma of the penis who underwent partial or total penectomy between 1987 and 2008. Patient age, tumour size, and grade; CD44 intensity score, cytological expression, topographic and distribution pattern were evaluated by immunohistochemistry on archived material and correlated with disease-specific survival.
  
  
  RESULTS
  mean patients age was 67.7 years; mean followup was 130.44 months. Bilateral inguinal lymphadenectomy was performed in 14 patients; there were 8 N+ patients (23.5%). pTis-pT1 vs. &gt; pT1 and the EAU classification of risk group resulted to be predictive of lymph nodal metastases at univariate analysis (respectively p = 0.006 and p = 0.045), but not the grading. The intensity score, cytological expression, topographic and distribution pattern of CD44 staining did not correlate with stage, grade and lymph nodes metastases. All disease related deaths occurred only in patients showing an high CD44 intratumoral expression, but this correlation is not statistically significant. Multivariate analysis showed that only lymph node metastasis was an independent prognostic factor predictive of lymph nodes metastases.
  
  
  CONCLUSIONS
  CD44 expression in patients with squamous cell carcinoma of the penis is not able to predict the need of performing inguinal lymphadenectomy; staging and the EAU classification of risk group resulted to be predictive of lymph nodal metastases.
authors.affiliation: Institute of Maternal and Children's Sciences-Urology, Polytechnic University of the Marche Region, Azienda Ospedaliero- Universitaria Ospedali Riuniti, Ancona. d.minardi@univpm.it.
authors.forename: Daniele
authors.initials: D
authors.lastname: Minardi
authors.forename: Guendalina
authors.initials: G
authors.lastname: Lucarini
authors.forename: Oriana
authors.initials: O
authors.lastname: Simonetti
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Primio
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muzzonigro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D018960:Hyaluronan Receptors / Q000378:metabolism; D007264:Inguinal Canal / Q000601:surgery*; D007558:Italy; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D018960:Hyaluronan Receptors