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The prognostic index: A useful pathologic guide for prediction of nodal metastases and survival in penile squamous cell carcinoma
American Journal of Surgical Pathology , 06/29/09

Chaux A et al. – Study concludes that if sentinel node biopsy cannot be performed in patients with penile carcinoma, the Prognostic Index might represent a useful pathologic guide to the clinicians in the often difficult decision to perform an inguinal dissection or not.

• A Prognostic Index combining the 3 factors: histologic grade, depth of tumor infiltration, and perineural invasion (PNI) was developed
• This study evaluates the incidence of nodal metastasis according to the Prognostic Index score
• Pathologic materials from 193 pts with penectomy/circumcision and bilateral groin dissections for invasive squamous cell carcinoma were analyzed
• Prognostic Index (ranging from 2-7) consisted in addition of:
  • Numerical values given to histologic grade (1 to 3)
  • Deepest anatomic level involved by cancer (1 to 3), and
  • Presence of PNI (0 or 1)
• Histologic grades defined as:
  • Grade 1, carcinomas with minimal to no atypias
  • Grade 3, tumors showing any proportion of anaplastic cells
  • Grade 2, the remainder tumors
• Penile intraepithelial neoplasia (carcinoma in situ), or index 1, was excluded from the study

• Mean f/u was 81 mo; distribution of cases and rate of metastasis according to index scores were:
  • 2 (1 case), no metastasis
  • 3 (17 cases), no metastasis
  • 4 (35 cases), 20% of metastasis
  • 5 (50 cases), 50% of metastasis
  • 6 (47 cases), 66% of metastasis, and
  • 7 (43 cases), 79% of metastasis
• Prognostic Index scores were the best predictors of inguinal node metastasis and pts' survival
• Inguinal node dissections might not be necessary for pts with low indices (2 and 3)
• Nodal dissections might be formally indicated for high-grade indexes (5 to 7)
• Pts with index 4 should be individually assessed for nodal dissection

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