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.
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.
['Patel|Keval N|KN|', 'Bhirud|Chirag|C|', 'Dipin|J|J|', 'Nandy|Kunal|K|', 'Venugopal|Vivek|V|', 'Salunke|Abhijeet|A|', 'Pandya|Shashank J|SJ|']
D002294:Carcinoma, Squamous Cell D016022:Case-Control Studies D019468:Disease Management D005500:Follow-Up Studies D006801:Humans D007264:Inguinal Canal D008197:Lymph Node Excision D008198:Lymph Nodes D008207:Lymphatic Metastasis D008297:Male D008875:Middle Aged D010412:Penile Neoplasms D011379:Prognosis D012189:Retrospective Studies D012307:Risk Factors
Inguinal lymph-nodes metastasis Cancer of penis Scoring methods