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Histopathological risk scoring system as a tool forpredicting lymph nodal metastasis in penile squamous cell carcinoma

In Pathology
By: Sali AP.
Contributor(s): Menon S [Corresponding Author] | Prakash G | Murthy V | Bakshi G | Mahanshetty U | Joshi A | Desai SB.
Material type: materialTypeLabelArticlePublisher: 2019Description: .Subject(s): Penile cancer | Lymph node metastasis | Penile squamous cellcarcinoma | Prognosis | Risk stratification | Scoring system In: Pathology Vol. 51, no. 7, p. 696-704.Summary: Penile cancer is an aggressive neoplasm and nodalmetastasis is a key factor in determining the outcome. Whilethere is a paucity of tools predicting nodal metastasis, anelective groin node dissection (GND) may cause severemorbidity. We aimed to devise a histopathology-based riskstratification system to predict the risk of nodal metastasis inpenile squamous cell carcinoma (SCC) patients.In this retrospective clinicopathological analysis, consecu-tive penile SCC patients who had undergone primary sur-gical treatment with GND from 2007 to 2012 were included.Histopathology slides were reviewed and a histopatholog-ical risk scoring system (ranging from 3 to 9) was devised byadding the values assigned to the following pathologicalvariables:tumourgrade(1–3);anatomical levelofinfiltration(1–3); and tumour infiltration pattern (1–3). Three riskgroupswere createdbasedonhistopathologicalriskscores.Final scores and risk groups were correlated with nodalmetastasis, disease-free survival (DFS) and overall survival(OS).We also validated the earlier described prognosticindex score (PIS) on our set of patients and compared it toour proposed scoring system.A total of 162 cases of primary penile resections withunilateral or bilateral groin node dissection were identifiedduring the study period. Sixty-two of 68 patients (91.17%)and 58 of 94 patients (61.7%) had nodal metastasis onupfront and follow-up nodal basin surgeries, respectively.Chances of nodal metastasis for each risk group were asfollows: low risk (score 3 and 4) 14.3%; intermediate risk(score 5) 52.6%; and high risk (scores 6–9) 83.7%.Follow-up was available in 145 patients (89.5%). Medianfollow-up was 21 months (1–96 months). The histopatho-logical scoring system (p=0.04) and risk groups (p=0.005)had a statistically significant correlation with DFS but notwith OS. Logistic regression model demonstrated that thisstratification system was a good predictor of nodalmetastasis. Further, this scoring system had better pre-dictive sensitivity for detecting true node-negative casesand marginally better accuracy in detecting nodal metas-tasis as compared to the PIS.Our study demonstrates that the histopathological riskstratification can predict nodal metastasis and aid in planning management of penile cancer patients with judi-cious implementation of the morbid procedure of GND.
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Address for Corresponding Author: mesantosh@gmail.com

Penile cancer is an aggressive neoplasm and nodalmetastasis is a key factor in determining the outcome. Whilethere is a paucity of tools predicting nodal metastasis, anelective groin node dissection (GND) may cause severemorbidity. We aimed to devise a histopathology-based riskstratification system to predict the risk of nodal metastasis inpenile squamous cell carcinoma (SCC) patients.In this retrospective clinicopathological analysis, consecu-tive penile SCC patients who had undergone primary sur-gical treatment with GND from 2007 to 2012 were included.Histopathology slides were reviewed and a histopatholog-ical risk scoring system (ranging from 3 to 9) was devised byadding the values assigned to the following pathologicalvariables:tumourgrade(1–3);anatomical levelofinfiltration(1–3); and tumour infiltration pattern (1–3). Three riskgroupswere createdbasedonhistopathologicalriskscores.Final scores and risk groups were correlated with nodalmetastasis, disease-free survival (DFS) and overall survival(OS).We also validated the earlier described prognosticindex score (PIS) on our set of patients and compared it toour proposed scoring system.A total of 162 cases of primary penile resections withunilateral or bilateral groin node dissection were identifiedduring the study period. Sixty-two of 68 patients (91.17%)and 58 of 94 patients (61.7%) had nodal metastasis onupfront and follow-up nodal basin surgeries, respectively.Chances of nodal metastasis for each risk group were asfollows: low risk (score 3 and 4) 14.3%; intermediate risk(score 5) 52.6%; and high risk (scores 6–9) 83.7%.Follow-up was available in 145 patients (89.5%). Medianfollow-up was 21 months (1–96 months). The histopatho-logical scoring system (p=0.04) and risk groups (p=0.005)had a statistically significant correlation with DFS but notwith OS. Logistic regression model demonstrated that thisstratification system was a good predictor of nodalmetastasis. Further, this scoring system had better pre-dictive sensitivity for detecting true node-negative casesand marginally better accuracy in detecting nodal metas-tasis as compared to the PIS.Our study demonstrates that the histopathological riskstratification can predict nodal metastasis and aid in planning management of penile cancer patients with judi-cious implementation of the morbid procedure of GND.

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