title: Predictors of Nodal Upstaging in Clinical Node Negative Patients With Penile Carcinoma: A National Cancer Database Analysis.
abstract: OBJECTIVE
  To examine the risk factors associated with upstaging at inguinal lymph node dissection (ILND) in men with penile cancer and clinically negative lymph nodes (cN0) using a large US cancer database.
  
  
  METHODS
  The National Cancer Data Base was queried from 1998 to 2012 to identify men with penile cancer who underwent ILND and had complete clinical or pathologic node status available. Lymphovascular invasion (LVI) was available after 2010. Multivariate logistic regression evaluated factors (cT stage, grade, LVI) associated with pathologic nodal upstaging in those with cN0 disease. Correlations between clinical and pathologic node status were also calculated with weighted kappa statistics.
  
  
  RESULTS
  Complete clinical and pathologic LN status was available for 875 patients. Of these, 461 (53%) were cN0. Upstaging occurred in 111 (24%). When stratified by low, intermediate, and high-risk groups, the proportion with pathologically positive LNs was 16%, 20%, and 27%, respectively (P = .12). On multivariate analysis, limited to men with LVI data available (N = 206), LVI (odds ratio 3.10, 95% confidence interval 1.39-6.92), but not increasing stage (univariate only) or grade (univariate only), was significantly associated with upstaging at ILND.
  
  
  CONCLUSIONS
  In this analysis, of 461 patients with node-negative penile cancer undergoing ILND, upstaging was observed in 24%. LVI was the strongest independent predictor of occult lymph node disease. These findings corroborate the presence of LVI as the significant risk factor for occult micrometastases and suggest a possible improvement in existing risk stratification groupings, with the presence of LVI, regardless of stage or grade, to be considered high-risk disease.
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA. Electronic address: wintersb@uw.edu.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Winters
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Mossanen
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Holt
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Lin
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Wright
mesh_terms: D000368:Aged; D016208:Databases, Factual; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States