Correlation Between Extent of Nodal Involvement and Depth of Invasion for Squamous Cell Carcinoma of Penis Following Prophylactic Groin Dissection

Abstract

Background: In Indian sub-continent the presentation of carcinoma penis is variable. The role and timing of inguinal lymph node dissection in patients with carcinoma penis is controversial and not clearly defined. For majority of patients, surgical excision is the most effective means of controlling the disease. Most patients present with palpable inguinal lymph nodes but not confirm of metastases. By classifying disease according to depth of invasion and degree of differentiation of the primary lesion a high degree of accuracy could be obtained in predicting the likelihood of positive groin nodes. The ability to predict cancer progression may help the clinical management of patients with penile squamous cell carcinoma. Materials and Methods: This is a retrospective observational study on carcinoma penis from a regional cancer centre of eastern India over a period from September 2016- April 2019. A total of 54 cases of invasive carcinoma of the penis were included in the study and details were retrieved from the surgical pathology files at our centre. All the patients’ results were analyzed and evaluated using appropriate statistical method.Results: Total 54 patients were included in the study out of which 19 patients underwent total penectomy while 35 patients underwent partial penectomy. Groin metastases were found in 11 out of 54 patients (20.37%). Nodal metastases were found in 6 of 41 grade I (14.63%) patients, 3 of 10 grade II patients (30%) and 2 out of 3 patients (66.66%) grade III patients. Among patients with depth of invasion greater than 6 mm,10 out of 42 patients (90.90%) had groin node metastasis, whereas for depth of invasion < 5mm 1 out of 12(9.09%) patients had groin node metastasis.Conclusion: Depth of invasion is associated with increased risk of groin metastases in case of squamous cell carcinoma of penis. Risk of metastases is further increased if there is presence of vascular invasion, extracapsular spread and higher grade.