Prognostic factors in penile cancer.

OBJECTIVES: To review the published data concerning the prognostic factors in patients with penile squamous cell carcinoma (SCC). METHODS: We performed an extensive literature search using the MEDLINE databases. Multiple "free text" searches were performed, searching for the following terms individually in the fields title and abstract of the records: "squamous cell carcinoma," "penile cancer" and "prognostic factors." The search included all studies published in English until November 2008. All selected reports were classified according to the level of evidence (LE). The final grade of recommendation (GR) was determined by discussion among all panel members of the International Consultation on Penile Cancer in November 2008. RESULTS: The presence of metastases in the regional lymph nodes is the main factor predicting an unfavorable prognosis for patients with penile SCC (LE 3, GR B). The prognosis varies according to the number of positive lymph nodes, the presence of uni- or bilateral inguinal extension, pelvic node involvement, and the presence of lymph node capsular involvement (LE 3, GR B). The histologic subtype, pathologic extension, histologic grade, and lymphatic and/or venous embolization are the most important variables of the primary tumor predicting for inguinal lymph node involvement (LE 3, GR B). CONCLUSIONS: The use of nomograms will allow for improvements in prognostic accuracy compared with the use of each single variable (LE 3, GR B). The use of molecular prognostic factors in clinical practice awaits additional confirmatory investigation (LE 3, GR B).