title: Lymph node density predicts recurrence and death after inguinal lymph node dissection for penile cancer.
abstract: To determine the impact of lymph node density (LND) on survival after inguinal lymph node dissection (ILND) for penile cancer.
  
  
  
  Our institutional penile cancer database was queried for patients who underwent ILND. Clinicopathologic characteristics including LND and total number of positive lymph nodes (LNs) were analyzed to determine impact on recurrence-free survival (RFS) and overall survival (OS). LND, or the percent of positive LN out of total LN, was calculated as a categorical variable at varying thresholds.
  
  
  
  Twenty-eight patients with complete follow-up were identified. Indications for ILND were stage >T2 in 20 patients (71.4%), palpable adenopathy in 7 (25%), high grade T1 in 1 (3.6%). Median node yield was 17.5 (interquartile range, 12-22), and positive LNs were found in 14 patients (50%). RFS and OS were significantly lower for patients with >15% LN density (median RFS: 62 months vs. 6.3 months, p=0.0120; median OS: 73.6 months vs. 6.3 months, p<0.001). Controlling for age, medical comorbidities, number of positive LN, T stage, pelvic LN status and indication, LN density >15% was independently associated with worse RFS (hazard ratio [HR], 3.6; p=0.04) and OS (HR, 73.6; p=0.002). The c-index for LND was higher than total positive LNs for RFS (0.64 vs. 0.54) and OS (0.79 vs. 0.61).
  
  
  
  In this small, retrospective penile cancer cohort, the presence of nodal involvement >15% was associated with decreased RFS and OS, and outperformed total number of positive LN as a prognostic indicator.
authors.affiliation: The James Buchanan Brady Urological Institute, Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ball
authors.affiliation: The James Buchanan Brady Urological Institute, Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Zeyad R
authors.initials: ZR
authors.lastname: Schwen
authors.affiliation: The James Buchanan Brady Urological Institute, Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Joan S
authors.initials: JS
authors.lastname: Ko
authors.affiliation: The James Buchanan Brady Urological Institute, Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Alexa
authors.initials: A
authors.lastname: Meyer
authors.affiliation: The James Buchanan Brady Urological Institute, Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Netto
authors.affiliation: The James Buchanan Brady Urological Institute, Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
authors.affiliation: The James Buchanan Brady Urological Institute, Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Lymph node excision; Neoplasm staging; Penile neoplasms; Survival analysis