Prophylactic inguinal lymphadenectomy for high-risk cN0 penile cancer: The optimal surgical timing
BackgroundFew reports have investigated the oncologically safe timing of prophylactic inguinal lymphadenectomy for penile cancer patients with clinically normal inguinal lymph nodes (cN0), particularly those who received delayed surgical treatment.MethodsThe study included pT1aG2, pT1b-3G1-3 cN0M0 p...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-02-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1069284/full |
| _version_ | 1828010815170543616 |
|---|---|
| author | Shanjin Ma Shanjin Ma Jian Zhao Zhiwei Liu Tao Wu Sheng Wang Chengwen Wu Lei Pan Xiaoye Jiang Zhihao Guan Yanjun Wang Dian Jiao Fengqi Yan Keying Zhang Qisheng Tang Jianjun Ma |
| author_facet | Shanjin Ma Shanjin Ma Jian Zhao Zhiwei Liu Tao Wu Sheng Wang Chengwen Wu Lei Pan Xiaoye Jiang Zhihao Guan Yanjun Wang Dian Jiao Fengqi Yan Keying Zhang Qisheng Tang Jianjun Ma |
| author_sort | Shanjin Ma |
| collection | DOAJ |
| description | BackgroundFew reports have investigated the oncologically safe timing of prophylactic inguinal lymphadenectomy for penile cancer patients with clinically normal inguinal lymph nodes (cN0), particularly those who received delayed surgical treatment.MethodsThe study included pT1aG2, pT1b-3G1-3 cN0M0 patients with penile cancer who received prophylactic bilateral inguinal lymph nodes dissection (ILND) at the Department of Urology of Tangdu Hospital between October 2002 and August 2019. Patients who received simultaneous resection of primary tumor and inguinal lymph nodes were assigned to the immediate group, while the rest were assigned to the delayed group. The optimal timing of lymphadenectomy was determined based on the time-dependent ROC curves. The disease-specific survival (DSS) was estimated based on the Kaplan–Meier curve. Cox regression analysis was used to evaluate the associations between DSS and the timing of lymphadenectomy and tumor characteristics. The analyses were repeated after stabilized inverse probability of treatment weighting adjustment.ResultsA total of 87 patients were enrolled in the study, 35 of them in the immediate group and 52 in the delayed group. The median (range) interval time between primary tumor resection and ILND of the delayed group was 85 (29-225) days. Multivariable Cox analysis demonstrated that immediate lymphadenectomy was associated with a significant survival benefit (HR, 0.11; 95% CI, 0.02–0.57; p = 0.009). An index of 3.5 months was determined as the optimal cut-point for dichotomization in the delayed group. In high-risk patients who received delayed surgical treatment, prophylactic inguinal lymphadenectomy within 3.5 months was associated with a significantly better DSS compared to dissection after 3.5months (77.8% and 0%, respectively; log-rank p<0.001).ConclusionsImmediate and prophylactic inguinal lymphadenectomy in high-risk cN0 patients (pT1bG3 and all higher stage tumours) with penile cancer improves survival. For those patients at high risk who received delayed surgical treatment for any reason, within 3.5 months after resection of the primary tumor seems to be an oncologically safe window for prophylactic inguinal lymphadenectomy. |
| first_indexed | 2024-04-10T09:06:10Z |
| format | Article |
| id | doaj.art-09e09b5618f5460a9178dfa8171e147a |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-10T09:06:10Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-09e09b5618f5460a9178dfa8171e147a2023-02-21T07:16:17ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-02-011310.3389/fonc.2023.10692841069284Prophylactic inguinal lymphadenectomy for high-risk cN0 penile cancer: The optimal surgical timingShanjin Ma0Shanjin Ma1Jian Zhao2Zhiwei Liu3Tao Wu4Sheng Wang5Chengwen Wu6Lei Pan7Xiaoye Jiang8Zhihao Guan9Yanjun Wang10Dian Jiao11Fengqi Yan12Keying Zhang13Qisheng Tang14Jianjun Ma15Department of Urology, Tangdu Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Urology, The 955th Hospital of Army, Changdu, ChinaDepartment of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Urology, Tangdu Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Urology, Tangdu Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Urology, The 955th Hospital of Army, Changdu, ChinaDepartment of Urology, The 955th Hospital of Army, Changdu, ChinaDepartment of Urology, The 955th Hospital of Army, Changdu, ChinaDepartment of Urology, Tangdu Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Urology, Tangdu Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Urology, Tangdu Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Urology, Tangdu Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Urology, Tangdu Hospital, Fourth Military Medical University, Xi’an, ChinaDepartment of Urology, Tangdu Hospital, Fourth Military Medical University, Xi’an, ChinaBackgroundFew reports have investigated the oncologically safe timing of prophylactic inguinal lymphadenectomy for penile cancer patients with clinically normal inguinal lymph nodes (cN0), particularly those who received delayed surgical treatment.MethodsThe study included pT1aG2, pT1b-3G1-3 cN0M0 patients with penile cancer who received prophylactic bilateral inguinal lymph nodes dissection (ILND) at the Department of Urology of Tangdu Hospital between October 2002 and August 2019. Patients who received simultaneous resection of primary tumor and inguinal lymph nodes were assigned to the immediate group, while the rest were assigned to the delayed group. The optimal timing of lymphadenectomy was determined based on the time-dependent ROC curves. The disease-specific survival (DSS) was estimated based on the Kaplan–Meier curve. Cox regression analysis was used to evaluate the associations between DSS and the timing of lymphadenectomy and tumor characteristics. The analyses were repeated after stabilized inverse probability of treatment weighting adjustment.ResultsA total of 87 patients were enrolled in the study, 35 of them in the immediate group and 52 in the delayed group. The median (range) interval time between primary tumor resection and ILND of the delayed group was 85 (29-225) days. Multivariable Cox analysis demonstrated that immediate lymphadenectomy was associated with a significant survival benefit (HR, 0.11; 95% CI, 0.02–0.57; p = 0.009). An index of 3.5 months was determined as the optimal cut-point for dichotomization in the delayed group. In high-risk patients who received delayed surgical treatment, prophylactic inguinal lymphadenectomy within 3.5 months was associated with a significantly better DSS compared to dissection after 3.5months (77.8% and 0%, respectively; log-rank p<0.001).ConclusionsImmediate and prophylactic inguinal lymphadenectomy in high-risk cN0 patients (pT1bG3 and all higher stage tumours) with penile cancer improves survival. For those patients at high risk who received delayed surgical treatment for any reason, within 3.5 months after resection of the primary tumor seems to be an oncologically safe window for prophylactic inguinal lymphadenectomy.https://www.frontiersin.org/articles/10.3389/fonc.2023.1069284/fullpenile canceringuinal lymphadenectomyprophylactic dissectiontiming of lymphadenectomydelayed |
| spellingShingle | Shanjin Ma Shanjin Ma Jian Zhao Zhiwei Liu Tao Wu Sheng Wang Chengwen Wu Lei Pan Xiaoye Jiang Zhihao Guan Yanjun Wang Dian Jiao Fengqi Yan Keying Zhang Qisheng Tang Jianjun Ma Prophylactic inguinal lymphadenectomy for high-risk cN0 penile cancer: The optimal surgical timing Frontiers in Oncology penile cancer inguinal lymphadenectomy prophylactic dissection timing of lymphadenectomy delayed |
| title | Prophylactic inguinal lymphadenectomy for high-risk cN0 penile cancer: The optimal surgical timing |
| title_full | Prophylactic inguinal lymphadenectomy for high-risk cN0 penile cancer: The optimal surgical timing |
| title_fullStr | Prophylactic inguinal lymphadenectomy for high-risk cN0 penile cancer: The optimal surgical timing |
| title_full_unstemmed | Prophylactic inguinal lymphadenectomy for high-risk cN0 penile cancer: The optimal surgical timing |
| title_short | Prophylactic inguinal lymphadenectomy for high-risk cN0 penile cancer: The optimal surgical timing |
| title_sort | prophylactic inguinal lymphadenectomy for high risk cn0 penile cancer the optimal surgical timing |
| topic | penile cancer inguinal lymphadenectomy prophylactic dissection timing of lymphadenectomy delayed |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1069284/full |
| work_keys_str_mv | AT shanjinma prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT shanjinma prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT jianzhao prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT zhiweiliu prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT taowu prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT shengwang prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT chengwenwu prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT leipan prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT xiaoyejiang prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT zhihaoguan prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT yanjunwang prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT dianjiao prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT fengqiyan prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT keyingzhang prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT qishengtang prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming AT jianjunma prophylacticinguinallymphadenectomyforhighriskcn0penilecancertheoptimalsurgicaltiming |