Scripties UMCG - Rijksuniversiteit Groningen
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Dynamische Schildwachtklier Biopsie in het kader van Diagnostiek naar Lymfekliermetastasen bij Peniscarcinoom: Oncologische Uitkomsten en Morbiditeit.

(2018) Wind, E.A.J. (Eelco)

Background and Purpose: Penile carcinoma is a rare neoplasm. Histopathologically, the most common diagnosis is squamous cell carcinoma (SCC). The risk developing metastatic disease increases with higher T- and G-stage of the local lesion. SCC has a reasonably well predictable distribution pattern through the lymphatic system. Dynamic Sentinel Node Biopsy (DSNB) is a reliable procedure for lymph node staging in patients with penile carcinoma and impalpable lymph nodes in order to detect possible metastases in sentinel nodes. Due to the rarity of the disease, relatively few studies exist about the evaluation of the minimally invasive DSNB procedure. The goals of this study were to evaluate oncologic outcomes of penile carcinoma in the North Netherlands region over the last 22 years, to evaluate morbidity and quality of nodal staging and attempt to identify risk factors for lymph node recurrence and the outcome of DSNB at our institution.
Methods: A retrospective chart review of consecutive men who were diagnosed with SCC of the penis, stage ≥T1G1, and treated between 1996 and 2018 at a single academic institution (University Medical Center Groningen) was performed. Premalignant lesions and malig-nancies other than SCC were excluded. Additional data has been obtained from the Netherlands Cancer Registry about the North Netherlands region (Groningen, Drenthe, Overijssel, Friesland) and compared to our population. Tumors were staged according to the TNM-classification. Oncologic outcomes were calculated as an interval between pathology report and the last clinical follow-up, death of the patient or recurrence of disease. Complications were graded according to the Clavien-Dindo classification. A univariate model was used to determine independent risk factors for recurrence of lymph node metastasis or the outcome of DSNB. A p < 0.05 was deemed significant.
Results: We identified 153 patients at our institution with an average age of 66.8 years and a mean follow up time of 30 months. Sentinel node metastasis was found in 23 patients out of 109 patients who underwent DSNB (21.1%). 5-year overall survival (OA), disease-specific survival (DSS), disease-free survival (DFS) and metastasis-free survival (MFS) were 66.1%, 83.0%, 73.5% and 80.9%, respectively. The average age in the regional population (n=327) was 69.1 years and the OA was 58.8%. The complication rate of DSNB was 8.3% and was significantly lower than bilateral inguinal lymph node dissection (p < 0.001). The false-negative rate of DSNB was 5.8%. Risk factor for DSNB outcome was G stage (p = 0.001). Risk factor for recurrence of inguinal or distant metastases was extranodal growth (p = 0.000).
Conclusion: Due to the increased experience as a result of the centralization of complex care and technical developments within healthcare, rare malignancies such as penile carcinoma can be treated more effectively. Adequate lymph node management is essential in the treatment of penile carcinoma. In our study, Dynamic Sentinel Node Biopsy had only minor morbidity and a low false-negative rate which is similar to the existing literature. Unnecessary morbidity can therefore be avoided in many patients.

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