European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Risk factors for contralateral inguinal lymph node metastases in unilaterally palpable groins in patients with squamous cell carcinoma of the penis.
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Patel Keval N, Sharma Mohit, Murlidharan Arunsrinivas, Suthar Nilkanth, Solanki Adesh, Shreyas D S, Medina Luis G, Bakshi Ganesh, Pandya Shashank J
Аннотация
OBJECTIVE: To assess the presence of contralateral inguinal lymph node metastases (ILNM) in unilaterally palpable groins and to identify risk factors (and a risk score) for non-palpable contralateral lymph node involvement.
MATERIALS AND METHODS: A retrospective analysis of 148 patients with unilaterally palpable inguinal lymph nodes who underwent bilateral inguinal lymph node dissection (bILND) was conducted. Survival analysis was performed using the Kaplan-Meier analysis to compare recurrence-free survival (RFS) and overall survival (OS). Logistic regression analysis was used to identify factors that could predict bilateral ILNM. A risk score was developed based on significant factors. The accuracy of the score was evaluated using the Receiver Operating Characteristic (ROC) curve.
RESULT: Bilateral ILNM was found in 43.9 % of patients and unilateral ILNM in 56.1 %. There was a significant decrement in OS in bilateral ILNM but not in RFS. On multivariate analysis, the number of positive lymph nodes >2, presence of lympho-vascular invasion (LVI), and poor differentiation significantly predicted bilateral ILNM. The probability of finding bilateral ILNM increased from 8.4 % with a score of 0-59.5 %, 73.3 %, and 81.2 % with scores of 1, 2, and 3, respectively. The Area under ROC (AUROC) of the risk scoring system was 0.982.
CONCLUSION: There is a significant risk of contralateral ILNM in cases of unilaterally palpable lymph nodes. Bilateral ILNM has lower OS than unilateral ILNM. Risk factors predicting bilateral ILNM are identified. bILND is suggested in >/ = 2 risk factors. Proper counselling and shared decision-making should govern the management of contralateral groin in patients with a single or no risk factor.
MATERIALS AND METHODS: A retrospective analysis of 148 patients with unilaterally palpable inguinal lymph nodes who underwent bilateral inguinal lymph node dissection (bILND) was conducted. Survival analysis was performed using the Kaplan-Meier analysis to compare recurrence-free survival (RFS) and overall survival (OS). Logistic regression analysis was used to identify factors that could predict bilateral ILNM. A risk score was developed based on significant factors. The accuracy of the score was evaluated using the Receiver Operating Characteristic (ROC) curve.
RESULT: Bilateral ILNM was found in 43.9 % of patients and unilateral ILNM in 56.1 %. There was a significant decrement in OS in bilateral ILNM but not in RFS. On multivariate analysis, the number of positive lymph nodes >2, presence of lympho-vascular invasion (LVI), and poor differentiation significantly predicted bilateral ILNM. The probability of finding bilateral ILNM increased from 8.4 % with a score of 0-59.5 %, 73.3 %, and 81.2 % with scores of 1, 2, and 3, respectively. The Area under ROC (AUROC) of the risk scoring system was 0.982.
CONCLUSION: There is a significant risk of contralateral ILNM in cases of unilaterally palpable lymph nodes. Bilateral ILNM has lower OS than unilateral ILNM. Risk factors predicting bilateral ILNM are identified. bILND is suggested in >/ = 2 risk factors. Proper counselling and shared decision-making should govern the management of contralateral groin in patients with a single or no risk factor.