Evidence for prognostic stratification in N3 penile cancer

Patients with N3 penile squamous cell cancer had a worse OS if they displayed extra-nodal extension in inguinal LNM or pelvic lymphadenopathy.

Further analysis of larger datasets is needed to verify the observed stratification of the TNM N3 group1

“Currently, TNM staging for penile squamous cell cancer distinguishes ‘clinical N3’, with fixed inguinal lymph node metastasis or pelvic lymphadenopathy, and ‘pathologic N3’, with pelvic lymph node metastasis and/or extra-nodal extension in any lymph node,” outlined Dr James Churchill (St George Hospital, Australia). The current study evaluated whether N3 staging can be further stratified based on pelvic lymphadenopathy and extra-nodal extension, to allow more accurate prognostication for patients and guide treatment decisions based on logical stage groupings. It was hypothesised that patients with pelvic lymphadenopathy had a worse prognosis than patients with extra-nodal extension in inguinal lymph node metastasis. In total, 213 patients were analysed retrospectively with OS being the primary outcome.

Patients without pelvic lymphadenopathy and extra-nodal inguinal lymph node extension had an improved OS compared with patients with either pelvic lymphadenopathy (HR 3.67 P<0.001) or inguinal lymph node extra-nodal extension (HR 1.99; P=0.006). Also, a numerical difference was observed between patients with extra-nodal extension (median OS of 25.4 months) and patients with pelvic lymphadenopathy (median OS of 19.6 months; P=0.19). In a corresponding multivariate analysis, patients with pelvic lymphadenopathy displayed a non-significant 62% increased risk of death compared with patients with inguinal lymph node extra-nodal extension (P=0.072).

1. Churchill J, et al. Survival in N3 penile cancer: Does pelvic lymphadenopathy predict a worse prognosis than inguinal extra-nodal extension? Abstract 0691, EAU 2022, 01–04 July.