Fatores de risco e prognóstico no câncer de pênis: um estudo epidemiológico

Abstract

Penile Cancer (PC) is a rare neoplasm. The most important prognostic factor in PC is lymph node (LN) involvement. Inguinal Lymphadenectomy (ILN) is the most accurate method for LN staging. Due to high morbidity and quality of life impairment, alternative staging modalities have been researched. This study aims to assess risk factors to determine prognosis in PC patients. A retrospective review was conducted on 84 males diagnosed with PC, between March 2014 and March 2019. Median age was 58.68 (± 12.98) years. The most common site for primary tumor was the glans, followed by foreskin and body of the penis. Thirty-Eight (45.2%) patients underwent ILN. The main reasons were primary tumor staging (pT2 and up) and palpable nodes in physical examination. Univariate analysis showed that significant risk factors were invasion of: penile body (p<0,05; IC95% 1.19 – 17.67), lymph vascular (p<0,05; IC 1.06 – 16.19), Dartos (p<0,05; IC95% 1.55- 183.21), Corpus Spongiosum (p<0,05; IC95% 1.15 – 39.39), Corpora Cavernosa (p<0,05; IC95% 1.32 – 19.9) and Lymph nodes (p<0,05; IC95% 7.99 – 284.44). In Cox Proportional overall survival (OS) analysis, penile body invasion (p<0,05; IC95% 1.11 – 12.017), lymph vascular invasion (p<0,05; IC95% 1.01 – 11.80), Dartos invasion (p<0,05; IC95% 2.02 – 29.27), lymph node invasion (p<0,05; IC95% 4.55 – 98.31) and more advanced primary lesion (p<0,05; IC95% 1.05 – 11.35) were associated with worst prognosis. Regarding recurrence and distant metastasis, the most important risk factors were lymph node invasion (p<0,05; IC95% 4.57 – 25.64), clinically palpable inguinal nodes (p<0,05; IC95% 1.38 – 8.97) and corpora cavernosa infiltration (p<0,05; IC95% 1.12 – 5.72). On a multivariate analysis, worst OS was related to lymph node invasion (p<0,05; IC95% 4.82 – 294.74) and clinically palpable inguinal nodes (p<0,05; IC95% 1.42 – 45.8), being the first also related to worst disease free survival. In follow up, most patients stayed disease free. From those who presented recurrence, 12 were inguinal lymph nodes and 3 in primary tumor site. PN+ patients required more invasive treatment, such as rescue surgery, chemotherapy or local radiotherapy. Eleven patients (13.1%) died from PC in this series, 9 from metastatic disease. Time from metastasis and death was 13,2 months, and mortality in M+ patients 55,6%. In this study we were able to confirm several risk factors for PC.