title: Extent of pelvic lymph node dissection in penile cancer may impact survival.
abstract: BACKGROUND
  Current guidelines on management of penile carcinoma (PC) recommend ipsilateral pelvic lymph node dissection (PLND) in patients with inguinal lymph node metastasis (LNM) who meet specific criteria. The aim of this article was to assess outcomes in patients treated with bilateral PLND in the presence of unilateral metastatic pelvic nodes.
  
  
  METHODS
  After IRB approval, four international centers contributed to this study. Men with PC and unilateral inguinal LNM and pelvic node metastases were retrospectively analyzed. Estimates of overall survival (OS) and cancer-specific survival were provided by the Kaplan-Meier method. Comparisons between subgroups were made using the log-rank test, and Cox regression analysis was used to adjust comparisons for covariates of interest.
  
  
  RESULTS
  From 1978 to 2012, fifty-one men with unilateral inguinal LNM and positive pelvic nodes on PLND were identified. Thirty-eight (75 %) had ipsilateral and 13 (25 %) had bilateral PLND. Except the extent of the PLND, patients were comparable with respect to disease and therapeutic interventions. The Kaplan-Meier estimated median OS was significantly longer in the bilateral PLND patients (21.7 vs. 13.1, p = 0.051). On Cox regression analysis, bilateral PLND [HR 0.25, (95 % CI 0.10-0.64)], multiple pelvic node involvement [HR 2.12 (95 % CI 1.02-4.43)], neoadjuvant chemotherapy [HR 0.01, (95 % CI 0.02-0.44)] and adjuvant therapies [HR 0.16, (95 % CI 0.06-0.45)] (compared to no additional therapy) were independent predictors of OS.
  
  
  CONCLUSIONS
  Men with PC and pelvic node metastases may benefit from a bilateral PLND. This hypothesis requires further confirmation.
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive Office 12538, Tampa, FL, 33612, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Zargar-Shoshtari
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive Office 12538, Tampa, FL, 33612, USA.
authors.forename: Pranav
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Urology, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Rosa
authors.initials: R
authors.lastname: Djajadiningrat
authors.affiliation: Department of Urology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Catanzaro
authors.affiliation: Fudan University Shanghai Cancer Center, Department of Urology, Shanghai, China.
authors.forename: Ding-Wei
authors.initials: DW
authors.lastname: Ye
authors.affiliation: Fudan University Shanghai Cancer Center, Department of Urology, Shanghai, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Urology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Nicolai
authors.affiliation: Department of Urology, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Simon
authors.initials: S
authors.lastname: Horenblas
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive Office 12538, Tampa, FL, 33612, USA. philippe.spiess@moffitt.org.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D002681:China / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010388:Pelvis; D010412:Penile Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: Algorithms; Lymph node excision; Penile neoplasms