The nodal nexus: Assessing the lymph node dynamics and outcomes in node-positive carcinoma of the penis.

e17030 Background: Although early-stage, organ-confined disease has favorable outcomes, lymph node metastasis is the strongest prognostic factor. Nearly one-third of patients present with nodal involvement, and 20–25% of clinically node-negative cases harbor occult metastases. Precise risk stratification in node-positive disease is therefore critical to optimize treatment and improve survival. Methods: This retrospective study analyzed medical records of 1200 patients treated for carcinoma of the penis at the Cancer Institute (WIA) between 1990 and 2022. Of these, 354 patients were pathologically node-positive and included in the final analysis. Demographics, tumor characteristics, nodal status, treatment modalities, and outcomes were recorded. Descriptive statistics summarized baseline data. Kaplan-Meier methods were used for survival analysis. Cox regression was employed to identify factors associated with overall survival (OS) and disease-free survival (DFS). Results: The cohort comprised 354 node-positive patients with a mean age of 52.7 years; 24.3% were smokers and 28.2% had comorbidities, mainly diabetes (10.5%) and hypertension (5.1%). Grade 2 tumors predominated (54.5%), with lymphovascular and perineural invasion seen in 7.6% and 3.2%, respectively. Nearly half were pN3 (48.6%), and extranodal extension (ENE) was present in 35.9%. Penile-preserving surgery was performed in 77.4%, with IIBD, PLND, and SIBD in 79.9%, 87.6%, and 88.4%, respectively. Adjuvant chemotherapy and PORT were administered in 20.1% and 5.4%. Recurrence occurred in 30.5%, predominantly nodal (12.7%). Five-year overall survival was ~60%, with a median OS of 100.3 months; median DFS was not reached, with 25% recurring within 13.8 months. Poor OS was associated with recurrence (HR 3.79), pN3 (HR 1.89), and pN2 disease (HR 1.75), while adjuvant chemotherapy was protective (HR 0.50). High LNR, ENE, bilateral nodal disease, and pelvic metastases correlated with inferior outcomes. Conclusions: Groin dissection is a key intervention in managing node-positive penile cancer. Nodal stage and recurrence are the strongest predictors of survival. Multimodality approaches, including early lymphadenectomy and adjuvant therapy, improve outcomes in high-risk patients. Despite available prognostic markers, most data remain retrospective and institution-specific. There is a need for multicenter prospective trials and individualized, multidisciplinary care strategies for this challenging subgroup.