Presentation Authors: Emanuel Albuquerque*, Giuliano Guglielmetti, Pablo Sierra, José Pontes Jr, Alexandre Cavalcante, Rafael Coelho, William Nahas, SÃO PAULO, Brazil
Introduction: The main predictor of survival in penile squamous cell carcinoma (PSCC) remains the presence and the extent of regional lymph node involvement. Despite being the standard of care for inguinal clinical node positive or inguinal clinical node negative with intermediate and high risk in PSCC, the radical inguinal lymph node dissection (ILND) is associated with significant morbidity and it may be an overtreatment in many patients. There is growing evidence to support the association of systemic inflammation in cancer development and progression. Therefore, we aimed to evaluate whether systemic inflammatory markers in peripheral blood before ILND can predict the presence of positive pathological nodes (pN+).
Methods: We retrospectively reviewed data from 230 patients with penile cancer followed between 2009 and 2018 in a single center, to identify 79 patients who were submitted to ILND for non-metastatic PSCC. We evaluated neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR) and platelet to lymphocyte ratio (PLR) obtained preoperatively. The cut-off point of NLR â‰¥ 3.0 was chosen following positive results found in previous studies in penile cancer and the cut-off point of LMR and PLR was chosen from its median. Logistic regression model was used to evaluate predictors of pN+.
Results: Median follow up was 35 months. On multivariable logistic regression, adjusted for age, staging T, histological grade, lymphovascular invasion and perineural invasion, NLR â‰¥ 3.0 (hazard ratio [HR] = 5.96; 95% confidence interval [CI]: 1.24-28.74, p = 0.026), PLR â‰¥ 127.33 (HR = 4.53; 95% CI: 1.29-15.86, p = 0.018) and LMR < 2.99 (HR = 7.62; 95% CI: 2.04-28.46, p = 0.003) were independent predictors of pN+. On multivariable logistic regression, adjusted for LMR, NLR, PLR, staging T, histological grade and lymphovascular invasion, the only ratio that remained statistically significant was LMR. When we stratified the LMR in 4 subgroups based on their values, we found the following percentages of pN+ (table 1)
Conclusions: The current report identify NLR, PLR and LMR before ILND in PSCC as independent predictors of pathological nodal involvement with the LMR being a more significant predictor. More studies are needed to confirm these findings.