The aim of this review was to identify prognostic pathologic factors which are independent from other clinical or molecular variables.
We reviewed the literature on morphological prognostic factors emphasizing our personal experience.
We found that for a proper evaluation of prognostic factors a familiarity with penile complex anatomy is required. A biopsy of the primary tumor is not useful for a complete evaluation of prognostic factors other than malignancy and a resected specimen should be utilized. Penile carcinomas have a fairly predictable pattern of local, regional and systemic spread. Pathologic factors affecting patients outcome are multiple but it is difficult from the available studies using heterogeneous pathologic methodologies, different therapeutic approaches and ecologically variable patient populations to ascertain the independent validity of these factors. Invasion of perineural spaces by tumor, lymphatic-venous embolization and histological grade appear to be the most important pathologic predictors of nodal spread and cancer mortality. Other commonly cited factors influencing prognosis are tumor depth or thickness, anatomical site and size of the primary tumor, patterns of growth, irregular front of invasion, pathologic subtypes of the SCC, positive margins of resection and urethral invasion. A combination of two factors, histological grade and depth has been reported as significant predictor of cancer regional spread. After a preselection of significant factors, nomograms have been constructed to collectively evaluate the predictive power of various clinical and pathological indicators.
Among various factors perineurial invasion, vascular invasion and high histological grade appear to be the most important adverse pathological prognostic factors.
"Penile carcinoma is characterized by a permanent progressive course that leads to death within two years in the majority of untreated patients. Spontaneous remissions have not been reported in the literature [6, 7]. "
[Show abstract][Hide abstract] ABSTRACT: Introduction
Penile carcinoma has an incidence of 4,000 cases in Europe. The therapy and prognosis depend decisively on the lymph node status. Lymph node metastases are detected in 23–65% cases depending on the histopathological pattern. Due to improved diagnostic methods an early detection of tumor stage is possible. Multimodal therapeutic concepts can offer curability for a subset of patients, even those suffering from advanced disease.
Material and methods
Current data on penile cancer based on a selective review of the literature by PubMed and the EAU guidelines 2009.
Invasive diagnostic tools, such as fine–needle biopsy (FNB) and dynamic sentinel node biopsy (DSNB), improved the diagnosis of lymph node status considerably and reduced the morbidity in specialized centers. The application of 18F–FDG–PET/CT for metastases detection needs further evaluation due to inconsistent results. Inguinal lymphadenectomy is the therapeutic standard in case of metastases proof. It was possible to reduce the complications due to the new modified operation techniques. Patients with extended lymph node and distant metastases have a poor prognosis. Different systemic polychemotherapy regimes are applied currently and are associated with poor outcome (response rates <50%) and high morbidity. Neoadjuvant chemotherapy is recommended in patients with unresectable and relapsing lymph node metastases.
Currently, inconsistent therapy regimens are applied for metastatic penile cancer. Standardization is urgently needed through the development of high–quality studies and long–term registers in order to lower the morbidity and increase the efficiency of diagnosis and therapy.
"Les deux localisations les plus fréquentes sont le gland (48 % des cas) et le prépuce (25 % des cas). Le pronostic du carcinome épidermoide est conditionné par sa profondeur d'infiltration, son grade histopronostique et l'existence d'emboles sanguins ou lymphatiques ou périnerveux . "
[Show abstract][Hide abstract] ABSTRACT: The applicability of neural networks to generate complex behaviour
on autonomous systems is demonstrated both at soft- and hardware-level.
In particular, the emergence of simple behaviors based on the
Braitenberg approach, adaptive sensor calibration by self-organizing
maps with a comparison between off- and online learning and a
visualisation tool for a posteriori analysis are shown. It is also
envisaged to present the working of embedded neural hardware as
associative memory and self-organizing maps. In this connection, the
mini-robot Khepera serves as an exemplary platform
Microelectronics for Neural, Fuzzy and Bio-Inspired Systems, 1999. MicroNeuro '99. Proceedings of the Seventh International Conference on; 02/1999
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