Research
Correlation of Lymph Node Density and Recurrence in Carcinoma Penis: A Perspective on Optimal Management and Unmet Needs from a Tertiary Care Centre
Introduction: Penile carcinoma is a devastating urological neoplasm in which the most assertive prognostic variable is the presence of lymph node involvement. Multiple studies in the current literature have shown that the number of positive lymph nodes predict recurrence free survival (RFS) and overall survival (OS). The objective of this present retrospective analysis is to authenticate the use of LND as a predictor of RFS and OS after ILND. Methods: Our institutional penile cancer database was analyzed for patients who underwent ILND from January 2000 to May 2008. Survival analysis was performed using the Kaplan- Meier method to determine RFS and OS. Two-sided p values <0.05 were considered significant. Results: Patients with complete follow up (n=33) were analyzed for clinico-pathological characteristics. LND≥40% was significantly predictive of poor recurrence free survival (Mantle Cox value: 13.609, p=.0005). RFS was significantly lower for patients with LND≥40% (mean survival: 46.22 month vs. 85.79 months, p=.001). Likewise, overall survival was lower in patients with LND≥40% but did not reach significant level (mean survival: 72.48 month vs. 85.30 months, p=.246). Conclusion: In multivariate Cox regression model continuously coded variables age (omnibus coefficient (OC) value: 1.108, p=.041), no. of positive lymph nodes removed (OC value: 3.681, p=.023), total no. of lymph nodes removed (OC value: 0.438, p=.014) were significant predictors of RFS but not OS in cases with LND≥40%. Recent developments in penile cancer may alter the prognostic significance of our LND cutoff of 40%.
Prognosis of Urinary Bladder TCC in Young Adults: A Single Center Experience
Introduction: Bladder TCC is rare in young adults and occurs more commonly in elderly individuals. The incidence of TCC urinary bladder is found to be 1% - 2.4% among young adults less than 40 years of age. Younger population has incidence of only .1% - .4% (age less than 20 yrs). Present study aimed to compare the clinical behavior, pathologic characteristics and prognosis of TCC urinary bladder in population between ≤ 30 and 31-40 yrs. Methods: A retrospective review of our records between Jan 2006 and Dec 2012 identified 71 patients with TCC bladder who were less than 40 years old. Clinical and pathological parameters of patients who were ≤ 30 years of age were compared with those of a series of patients between 31- 40 years of age during the same period. Results: Multivariate logistic regression analysis revealed high tumor grade and multifocality as predominant predictors of tumor recurrence in young patients. A Significant difference was observed in the recurrence-free (p <.018) and progression- free (p < 0.06) survival rates between the two groups. Conclusion: We concluded that although the clinical stage distribution, natural history, and outcomes of bladder TCC in young adults are similar to those in their older counterparts, Clinicians must be aware that patients with higher-grade and multifocal tumors are more likely to experience tumor recurrence and grade progression.
