Prognostic Factors in Node Negative Penile Cancer.

The most common malignant tumor of the penis is squamous cell carcinoma. Other malignant tumors though rare include, basal cell carcinoma, melanoma, sarcomas (most common are the hemagioendothelioma, followed by neural, myogenic and fibrous tumors), Paget’s disease, surface adeno squamous carcinoma, lympho reticular malignancies, and finally, metastases (most commonly from the bladder, prostate and rectum). The incidence rates of squamous cell carcinoma of the penis in India are as follows 0.88/100,000 population (crude incidence rate),1.23/100,000 population (Age standardized (world) rate),and 0.17 % cumulative risk 8.Among the nine population based cancer registries in India, the Madras Metropolitan Tumor Registry(MMTR)shows the highest incidence rates. Crude incidence rate of 1.43/100,000 population, Age Standardized Rate of 1.81/100,000 population and a cumulative risk of 0.23 %. OBJECTIVES : 1. To study the long term survival of patients with squamous cell carcinoma of the penis, treated at Cancer Institute(WIA) 2. To identify prognostic factors influencing survival in these patients. 3. To study outcomes of node negative patients, their patterns of failure and analyze prognostic factors. 4. To study outcomes of node positive patients, their outcomes with respect to the extent of nodal involvement and other prognostic factors. 5. To risk stratify node negative patients according to primary tumor pathological “T” status and grade, and identify subgroups who will benefit from prophylactic lymphadenectomy. CONCLUSION : It is evident from this study that the nodal status is the single most important factor affecting survival in all penile cancer patients. Among the node negative patients, development of recurrence in the nodes is the most important prognostic factor. In node positive patients, the extent of nodal involvement as represented by the pathological “N” status is the most important prognostic factor. The policy of observation of clinically node negative patients after penectomy has been validated in this study. Only 15% of this group ultimately failed in the nodes. The 5 years overall survival was the same in both the clinically node positive patients who presented upfront and the clinically node negative patients who were observed but failed in the nodes. The time to recurrence did not significantly affect survival. 5 years overall survival rates of node negative and node positive patients in this study are comparable to those reported in contemporary series. Further, among the clinically node negative patients, 36% of pT3,4 grade 3 tumors and 36% of pT1,2 Grade 3 tumors, failed in the nodes. Hence, this may be a subgroup of patients who will benefit from prophylactic lymphadenectomy. It has to be studied prospectively whether such a measure will improve the survival of these patients