A proposed Clino-radio-pathological Risk Scoring System (CRiSS) for prediction and management of inguinal lymph-nodes metastasis in squamous cell carcinoma of the penis. (March 2021)

• Record Type: Journal Article
• Authors: Patel, Keval N.; Bhirud, Chirag; Dipin, J.; Nandy, Kunal; Venugopal, Vivek; Salunke, Abhijeet; Pandya, Shashank J.
• Is Part Of: Surgical oncology. Volume 36(2021)
• Page Start: 147
• Page End: 152
• Publication Date: 2021-03
• Subjects: Cancer of penis -- Scoring methods -- Inguinal lymph-nodes metastasis; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2020.12.010
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Objective: To develop a risk scoring system for prediction of inguinal lymph-node involvement and to suggest a management strategy according to the risk groups based on clinical, radiological and pathological parameters in squamous cell carcinoma (SCC) of penis. Materials and Methods: A retrospective analysis of all patients of SCC penis from 2014 to 2020 at our institute was done. The patients were divided into derivation cohort (2014 to 2019) and validation cohort (2019 to 2020). A total of 10 predictors were analysed in univariate analysis and those found significant were further subjected to multivariate analysis to derive regression coefficient for each. CRiSS scores were assigned based on the coefficients and three groups were created which were correlated with nodal metastasis. The predictive accuracy of the model was assessed by ROC analysis of the derivation cohort and validation cohort. Results: A total of 102 patients were identified in derivation cohort and 23 patients in validation cohort. Size of the primary >3cm, ulceroinfiltrative growth, involving shaft, ultrasound size of lymph-nodes >1cm, loss of fatty hila, moderate and poor differentiation, and lypmphovascular/perineural invasion were independent predictors of inguinal lymphnode metastasis in multivariate analysis. CRiSS could achieve AUROC of .910 and .887 in derivation and validation cohort respectively. The rate of metastatic lymphadenopathy was 0%, 41.4%, and 89.5% in low, intermediate, and high-risk groups respectively. Conclusions: CRiSS can effectively predict inguinal lymph-node metastasis in SCC penis. We suggest a management strategy based on risk groups that will avoid morbidity of groin dissection in many patients. Highlights: The current study proposes a C lino-radio-pathological Ri sk S coring S ystem (CRiSS) in Squamous Cell Carcinoma (SCC) of penis. CRiSS accurately predicts metastasis in clinically palpable (cN+) as well as non-palpable (cN0) lymph-nodes in SCC penis. CRiSS is a useful objective tool in decision making of upfront groin dissection along with the primary surgery in SCC penis.