Surveillance or Dynamic Sentinel Lymph-Node Biopsy in Low-Risk Clinically N0 Penile Squamous Cell Carcinoma: Single-Institution Real World Data

• Published in: Clinical genitourinary cancer 2024-04, Vol.22 (2), p.544-548
• Main Authors: Nazzani, Sebastiano, Catanzaro, Mario, Bruniera, Martina, Torelli, Tullio, Macchi, Alberto, Stagni, Silvia, Tesone, Antonio, Silvani, Carlo, Ceccato, Tommaso, Bernasconi, Valentina, Lanocita, Rodolfo, Cascella, Tommaso, Claps, Melanie, Giannatempo, Patrizia, Zimatore, Matteo, Cattaneo, Laura, Biasoni, Davide, Montanari, Emanuele, Nicolai, Nicola
• Format: Article
• Language: English
• Subjects: Carcinoma, Squamous Cell - pathology; Early stages; Humans; Male; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Penile Neoplasms; Penile Neoplasms - pathology; Risk Factors; Sentinel Lymph Node Biopsy
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2024.01.009

•Most of the low-risk PeSCC have a good prognosis and would not deserve an adjuvant treatment.•Almost all relapses occur within 1 year (6 out of 7), and this arises the question of how plan surveillance, specifically addressing the early period with frequent examinations and visits.•Younger patients, considered the higher risk of relapse, may be placed in discussion for mini-invasive staging of lymph nodes, as an alternative to observation alone. Surveillance is the standard management in low-risk cN0 penile squamous cell carcinoma (peSCC) patients. However, no previous analysis focused on early and long-term outcomes of these patients. We report on main oncological outcomes of a large series of low-risk cN0 peSCC patients. Between 1980 and 2017 included, 93 evaluable consecutive low-risk (ie, pT1a G1 cN0M0) peSCC patients underwent primary tumor surgery and either observation (74) or dynamic sentinel node biopsy (DSNB) (19) following a clinical diagnosis of T1 in 66 (71%), T2 in 15 (16.1%) and Tx in 12 (12.9%) patients, respectively. The statistical significance of differences in medians and proportions was tested with the Kruskal-Wallis and chi-square tests. Kaplan-Meier plots illustrated 5-year inguinal relapse (IR)-free survival rates. Median age was 60 years (IQR: 50-69 years). Median follow-up was 92 months (IQR 54-133 months). Surveillance was more frequently adopted in clinical (c)T1 than in cT2 tumors (79.7% vs. 36.8%). None of 19 patients who had DSNB had nodal metastasis. Overall, 7 (7.5%) out of 93 pT1aG1cN0 peSCC patients had IR after a median interval of 9 months. Of note, 1 patient only relapsed after 12 months of surveillance. After stratification according to IR, relapses occurred more frequently in younger patients (59 vs. 64 years, P < .001). The 5-year IR-free survival rates for the entire cohort was 92% (95% Confidence interval [CI] 87-98%). Observation is a safe and effective management for low-risk peSCC patients. Younger patients may be offered a mini-invasive staging as an alternative. Surveillance is the standard management in low-risk cN0 penile squamous cell carcinoma (peSCC) patients. We report on main oncological outcomes of a series of low-risk cN0 peSCC patients. Patients underwent primary tumor surgery and either observation or dynamic sentinel node biopsy. Observation is a safe and effective management for low-risk peSCC patients. Younger patients may be offered a mini-invasive staging.