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MP10-14 PREDICTING INGUINAL AND PELVIC LYMPH NODE STATUS IN PENILE CANCER PATIENTS: A COMPARISON OF COMPUTED TOMOGRAPHY AND DISEASE BURDEN OF INGUINAL LYMPH NODES
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Saturday, May 17, 2014
e119
MP10-14 PREDICTING INGUINAL AND PELVIC LYMPH NODE STATUS IN PENILE CANCER PATIENTS: A COMPARISON OF COMPUTED TOMOGRAPHY AND DISEASE BURDEN OF INGUINAL LYMPH NODES Rajan Veeratterapillay*, Newcastle upon tyne, United Kingdom; Luke Teo, S. Asterling, P. Keegan, Damian Greene, SUNDERLAND, United Kingdom
Source of Funding: none
MP10-13 OBESITY INCREASES THE RISK OF INVASIVE PENILE CANCER Kerri Barnes*, Bradley McDowell, Anna Button, Brian Smith, Charles Lynch, Amit Gupta, Iowa City, IA INTRODUCTION AND OBJECTIVES: We have previously reported an association between obesity and higher risk of invasive penile cancer in a hospital-based retrospective study. In order to validate the association between obesity and penile cancer at a population level, we conducted a matched case-control study linking the Iowa Department of Motor Vehicles Drivers’ License Database (DLD) with cancer surveillance data collected by the State Health Registry of Iowa (SHRI). METHODS: All men diagnosed with invasive penile squamous cell carcinoma from 1973 to 2010 were identified by the SHRI. Three hundred-thirty cancer cases and 990 cancer-free male controls, selected from the Iowa DLD, were matched within 5-year age and calendar year strata at a ratio of 3 controls to each case . Body mass index (BMI) was calculated using self-reported height and weight from the DLD. Conditional logistic regression was used to evaluate the association between BMI and the risk of developing invasive penile cancer. RESULTS: Penile cancer cases were significantly more likely to be overweight or obese as compared to controls. Compared to men with a normal weight (BMI < 25), the risk of invasive penile cancer increased with increasing obesity (Table). When BMI was treated as a continuous variable in the analysis, the risk of invasive penile cancer increased by an estimated 55% for every five-unit increase in BMI (Table). CONCLUSIONS: In this population-based matched case-control study, we found that increasing BMI was associated with a higher risk of developing invasive penile cancer. These results are consistent with our previous hospital-based study. Greater emphasis on education of obese men about this risk might encourage weight loss and persuade them to perform periodic genital self-examination. Table BMI Summary from Conditional Logistic Regression Statistics
BMI Categories
Cases
Controls
N (%)
N (%)
Total
OR (95% CI)
p-value
< 25
65 (19.70)
360 (36.36)
425
1.0
Ref
25-29.99 (overweight)
187 (56.67)
472 (47.68)
659
2.36 (1.70-3.27)
0.0205
236
2.99 (2.00-4.48)
<0.0001
1.55 (1.32-1.81)y
<0.0001
≥30 (obese) BMI (kg/m2)
78 (23.64)
158 (15.96)
Mean (SD)
Mean (SD)
28.00 (3.58)
26.60 (4.30)
y Estimated effect for a 5-unit increase in BMI as a continuous variable
Source of Funding: This work was made possible by the University of Iowa Holden Comprehensive Cancer Center Population Research Core which is supported in part by P30 CA086862 and the Iowa Cancer Registry which is supported in part by HSN261201000032C.
INTRODUCTION AND OBJECTIVES: Lymph node status is of paramount importance in penile cancer management as it correlates with patient survival. Pelvic computed tomography (CT) has been used in initial staging and surveillance for pelvic and inguinal lymph nodes with variable accuracy. The aim of this study was to evaluate the accuracy of CT in assessment of inguinal lymph nodes and also the role of CT and burden of inguinal lymph nodes in predicting pelvic lymph node involvement. METHODS: Patients with biopsy proven penile SCC treated at our centre (Sunderland Royal Hospital, UK), in the period January 2000 to December 2010, were identified from a prospectively acquired departmental database. We compared correlated pre-operative CT findings of enlarged pelvic or inguinal nodes (>8mm) to pathological findings in patients who had subsequent inguinal and pelvic lymph node dissection (ILND and PLND). Kaplan Meier (KM) analysis was performed to compare survival outcomes. RESULTS: We treated 192 patients with penile cancer in that period out of whom 79 patients underwent ILND and 17 PLND. ILND was performed in patients with high risk disease (high grade/local stage/ adverse pathological characteristics) or if nodes were palpable or positive on imaging. Out of the 79 inguinal lymph nodes, 33 were positive. CT scan for identifying positive ILND had a sensitivity of 45.5%, specificity of 76.5%, positive predictive value (PPV) of 57.7% and negative predictive value (NPV) of 66.6%. For pelvic lymph nodes, CT had sensitivity 66.6%, specificity 45.5%, PPV 40% and NPV 71.4%. The number of positive inguinal lymph nodes correlated more closely with the chance of finding positive pelvic nodes. KM plots showed a five year cancer specific survival of 92.6% with N0, 71.6% in N1, 60.6% in N2 and 57.1% in N3 disease. CONCLUSIONS: Pelvic CT imaging and is of limited use in predicting microscopic pelvic lymph node metastasis due to its low sensitivity and specificity. Pathological characteristics of the inguinal LNs remain the essential indicators of a positive PLND. Source of Funding: none
MP10-15 DYNAMIC SENTINEL LYMPH NODE BIOPSY IN PENILE CANCER: A SINGLE CENTRE EXPERIENCE € l, Raj Prasenjit Pal, Jonathan Charles Goddard, Jonathan Patrick Noe Tim Robin Terry, Yvonne Rees, John Paul Dormer, Duncan John Summerton, Leicester, United Kingdom INTRODUCTION AND OBJECTIVES: Dynamic sentinel lymph node biopsy (DSNB) has become the recommended approach to assess lymph node status in men with clinically impalpable inguinal nodes and G2T1 penile cancer. A limited number of centres publish results and require validation from other groups. We present intermediate term outcomes of our patients undergoing DSNB in a supraregional tertiary referral penile cancer centre. METHODS: All patients with G2T1 penile squamous cell carcinoma and non-palpable nodes underwent uni/bilateral DSNB between July 2010 to September 2013. Patients were assessed by lymphoscintigraphy using (99m) technetium labelled nanocolloid, followed by inguinal ultrasound scan on the morning of surgery. At the time of anaesthetic induction, 1ml of patent blue dye was injected into the proximal penile shaft. Retrieval of sentinel nodes was facilitated by the use of pre-operative lymphoscintigraphic images and intra-operative detection of radiotracer and patent blue dye. The primary outcome
Vol. 191, No. 4S, Supplement, Saturday, May 17, 2014
e119
MP10-14 PREDICTING INGUINAL AND PELVIC LYMPH NODE STATUS IN PENILE CANCER PATIENTS: A COMPARISON OF COMPUTED TOMOGRAPHY AND DISEASE BURDEN OF INGUINAL LYMPH NODES Rajan Veeratterapillay*, Newcastle upon tyne, United Kingdom; Luke Teo, S. Asterling, P. Keegan, Damian Greene, SUNDERLAND, United Kingdom
Source of Funding: none
MP10-13 OBESITY INCREASES THE RISK OF INVASIVE PENILE CANCER Kerri Barnes*, Bradley McDowell, Anna Button, Brian Smith, Charles Lynch, Amit Gupta, Iowa City, IA INTRODUCTION AND OBJECTIVES: We have previously reported an association between obesity and higher risk of invasive penile cancer in a hospital-based retrospective study. In order to validate the association between obesity and penile cancer at a population level, we conducted a matched case-control study linking the Iowa Department of Motor Vehicles Drivers’ License Database (DLD) with cancer surveillance data collected by the State Health Registry of Iowa (SHRI). METHODS: All men diagnosed with invasive penile squamous cell carcinoma from 1973 to 2010 were identified by the SHRI. Three hundred-thirty cancer cases and 990 cancer-free male controls, selected from the Iowa DLD, were matched within 5-year age and calendar year strata at a ratio of 3 controls to each case . Body mass index (BMI) was calculated using self-reported height and weight from the DLD. Conditional logistic regression was used to evaluate the association between BMI and the risk of developing invasive penile cancer. RESULTS: Penile cancer cases were significantly more likely to be overweight or obese as compared to controls. Compared to men with a normal weight (BMI < 25), the risk of invasive penile cancer increased with increasing obesity (Table). When BMI was treated as a continuous variable in the analysis, the risk of invasive penile cancer increased by an estimated 55% for every five-unit increase in BMI (Table). CONCLUSIONS: In this population-based matched case-control study, we found that increasing BMI was associated with a higher risk of developing invasive penile cancer. These results are consistent with our previous hospital-based study. Greater emphasis on education of obese men about this risk might encourage weight loss and persuade them to perform periodic genital self-examination. Table BMI Summary from Conditional Logistic Regression Statistics
BMI Categories
Cases
Controls
N (%)
N (%)
Total
OR (95% CI)
p-value
< 25
65 (19.70)
360 (36.36)
425
1.0
Ref
25-29.99 (overweight)
187 (56.67)
472 (47.68)
659
2.36 (1.70-3.27)
0.0205
236
2.99 (2.00-4.48)
<0.0001
1.55 (1.32-1.81)y
<0.0001
≥30 (obese) BMI (kg/m2)
78 (23.64)
158 (15.96)
Mean (SD)
Mean (SD)
28.00 (3.58)
26.60 (4.30)
y Estimated effect for a 5-unit increase in BMI as a continuous variable
Source of Funding: This work was made possible by the University of Iowa Holden Comprehensive Cancer Center Population Research Core which is supported in part by P30 CA086862 and the Iowa Cancer Registry which is supported in part by HSN261201000032C.
INTRODUCTION AND OBJECTIVES: Lymph node status is of paramount importance in penile cancer management as it correlates with patient survival. Pelvic computed tomography (CT) has been used in initial staging and surveillance for pelvic and inguinal lymph nodes with variable accuracy. The aim of this study was to evaluate the accuracy of CT in assessment of inguinal lymph nodes and also the role of CT and burden of inguinal lymph nodes in predicting pelvic lymph node involvement. METHODS: Patients with biopsy proven penile SCC treated at our centre (Sunderland Royal Hospital, UK), in the period January 2000 to December 2010, were identified from a prospectively acquired departmental database. We compared correlated pre-operative CT findings of enlarged pelvic or inguinal nodes (>8mm) to pathological findings in patients who had subsequent inguinal and pelvic lymph node dissection (ILND and PLND). Kaplan Meier (KM) analysis was performed to compare survival outcomes. RESULTS: We treated 192 patients with penile cancer in that period out of whom 79 patients underwent ILND and 17 PLND. ILND was performed in patients with high risk disease (high grade/local stage/ adverse pathological characteristics) or if nodes were palpable or positive on imaging. Out of the 79 inguinal lymph nodes, 33 were positive. CT scan for identifying positive ILND had a sensitivity of 45.5%, specificity of 76.5%, positive predictive value (PPV) of 57.7% and negative predictive value (NPV) of 66.6%. For pelvic lymph nodes, CT had sensitivity 66.6%, specificity 45.5%, PPV 40% and NPV 71.4%. The number of positive inguinal lymph nodes correlated more closely with the chance of finding positive pelvic nodes. KM plots showed a five year cancer specific survival of 92.6% with N0, 71.6% in N1, 60.6% in N2 and 57.1% in N3 disease. CONCLUSIONS: Pelvic CT imaging and is of limited use in predicting microscopic pelvic lymph node metastasis due to its low sensitivity and specificity. Pathological characteristics of the inguinal LNs remain the essential indicators of a positive PLND. Source of Funding: none
MP10-15 DYNAMIC SENTINEL LYMPH NODE BIOPSY IN PENILE CANCER: A SINGLE CENTRE EXPERIENCE € l, Raj Prasenjit Pal, Jonathan Charles Goddard, Jonathan Patrick Noe Tim Robin Terry, Yvonne Rees, John Paul Dormer, Duncan John Summerton, Leicester, United Kingdom INTRODUCTION AND OBJECTIVES: Dynamic sentinel lymph node biopsy (DSNB) has become the recommended approach to assess lymph node status in men with clinically impalpable inguinal nodes and G2T1 penile cancer. A limited number of centres publish results and require validation from other groups. We present intermediate term outcomes of our patients undergoing DSNB in a supraregional tertiary referral penile cancer centre. METHODS: All patients with G2T1 penile squamous cell carcinoma and non-palpable nodes underwent uni/bilateral DSNB between July 2010 to September 2013. Patients were assessed by lymphoscintigraphy using (99m) technetium labelled nanocolloid, followed by inguinal ultrasound scan on the morning of surgery. At the time of anaesthetic induction, 1ml of patent blue dye was injected into the proximal penile shaft. Retrieval of sentinel nodes was facilitated by the use of pre-operative lymphoscintigraphic images and intra-operative detection of radiotracer and patent blue dye. The primary outcome