Low Yield of Pathological Lymph Node Metastasis among Patients with invasive Penile Squamous Cell Carcinoma in the Context of High HIV Burden; Evidence from a Prospective Cohort Study in Zambia

Victor Mapulanga^1*Owen Ngalamika¹Chibamba Mumba¹Zoran Muhimbe¹Curtis A Pettaway²Kasonde Bowa³Edford Sinkala¹

• ¹University of Zambia, Lusaka, Zambia
• ²The University of Texas MD Anderson Cancer Center Gastrointestinal Cancer Center, Houston, United States
• ³University of Lusaka, Lusaka, Zambia

Introduction Penile Squamous cell carcinoma PSCC) is common in developing countries such as those in sub-Saharan Africa (SSA) and has been attributed to a high prevalence of human papilloma virus (HPV). Additionally, since the prevalence of human immunodeficiency virus (HIV) is high in SSA, and considering that HIV causes reactive lymphadenopathy, this may potentially affect the clinical manifestation, including staging and surgical management of inguinal lymph nodes in PSCC. Data on surgical staging via inguinal lymph node dissection (ILND) in penile cancer patients from areas of high HIV burden like SSA are scanty. We evaluated the use of ILND as a staging tool to determine the status of inguinal lymph nodes in patients with invasive PSCC in the context of a high HIV burden. Methods This was a prospective cross-sectional study of participants recruited between November, 2022 and January, 2024 at the University Teaching Hospital in Lusaka, Zambia. Patients with surgically resectable PSCC that underwent surgery for both primary tumor and inguinal lymph nodes simultaneously were recruited into the study. A questionnaire was administered to capture relevant clinical information. The dissected lymph nodes were pathologically analyzed for lymph node number, size and the presence of metastasis (LNM). Results Forty patients were enrolled in the study with the mean age of 53 years (SD 10.28). Thirty-five patients (87.5%) were HIV seropositive with most patients being virologically suppressed at the time of surgery. Thirty-two patients (80%) presented with clinically palpable inguinal lymph nodes (cN+). The yield of pathological lymph node metastasis (LNM) from surgical staging was 37.5% (12/32) in patients with clinically palpable (cN+) inguinal lymph nodes. Conclusion The study demonstrates a modest low yield of pathological inguinal lymph node metastasis in patients with clinically palpable nodes in the context of a high HIV burden. Minimally invasive biopsy techniques to assess nodal status should be explored in this setting to reduce the morbidity associated with surgical staging while accurately assessing nodal status.