STUDY OF PREDICTORS OF INGUINAL LYMPH NODE METASTASIS IN CARCINOMA PENIS

Background:Penile cancer although a rare cancer, its not uncommon in India. Indian incidence ranges from 0.7-3/100000 males.Clinical guidelines available for decision making, still it remains a complex issue as far as predicting the outcome. The presence of metastatic disease produces considerable morbidity in patients with penile cancer. By doing this study we want to study which factors both clinically and histologically were predictive of lymph node involvement, pattern of lymph node involvement and extent of disease in nodal regions. Patients and Methods:A total of 38 cases between January 2018 to February 2020 were included in study. Metastatic carcinoma penis were excluded. The study was conducted in the Department of surgical oncology MNJIO&RCC OSMANIA MEDICAL COLLEGE.All cases of biopsy proven carcinoma penis were evaluated. Time period of study was from January 2018 to January 2020.Lymph node status was predicted preoperatively by clinical examination and imaging using ultra sound and CT scan. All cases irrespective of lymph node status were managed by surgery of primary and bilateral inguinal node dissection .Both clinical and histological factors were assessed. A total of 43 patients presented with penile cancer in the specified duration to our institute , of which, 1 patient had lung mets and was excluded, 2 patients were not willing for lymph nodal addressing surgery and were omitted from the study. Results: In our study post surgery 14 patients {35%} had positive lymph nodal disease of which 10 patients had unilateral inguinal lymph node involvement and 4 had bilateral inguinal lymph node involvement . 2 patients had pelvic lymph node involvement.Of the 40 cases in our study 23 patients had clinically involved nodes , 17 had no clinical involvement of lymph nodes . Of the 23 cases of clinically involved nodes 11 patients had histopathological conformation of nodal involvement {47.8%}. The relative risk of histopathological node positivity in clinical involved nodes is 2.71. odds ratio was 4.27 .The p value is 0.0479, so clinical node involvement is a significant criteria for pathological node involvement in our study. Conclusion:In clinically positive nodes only 50% of patients have actual histopathological involvement of disease. And 15 to 20% of patients with clinically negative nodes had post op histopathological confirmation of nodal involvement. Most significant predictive factors for lymphnode involvement in our study though with small sample size were tumor grade 3{poorly differentiated,tumor} ,depth of invasion greater than 1cm ,Clinical node involvement ,lymphovascular invasion. Other factors which had high relative risk and odds ratio were grade 2 tumor,size of greater than 4cms , perineural invasion, depth between 0.5 to 1cm.