The importance of microvessel density in predicting cancer progression in patients with penile squamous cell carcinoma.

PURPOSE: To evaluate the role of microvessel density (MVD) in predicting lymph node (LN) metastasis in penile squamous cell carcinoma (PSCC).

MATERIALS AND METHODS: Records of 266 patients with PSCC were analyzed. Parameters examined were tumor stage, grade, nodal status, intratumoral and peritumoral MVD. Univariate and multivariate analyses were used to evaluate association between different histopathological variables and MVD. ROC was plotted to derive a prediction model using appropriate cutoff values of the parameters predicting cancer progression.

RESULTS: 77 patients were found to have histologically proven metastatic LN. MVD did not correlate significantly with T stage and grade of tumor. The intratumoral and peritumoral MVD of patients with metastatic LN was significantly higher than patients with negative LN (58.92 vs. 49.89 and 65.57 vs. 53.72, respectively; P < 0.0001). Multivariate analysis also revealed that MVD (intratumoral and peritumoral) was independent predictor for LN metastasis. From ROC curve, at the cutoff value of 54, intratumoral MVD predicted LN metastasis with sensitivity of 91% and specificity of 87%. Similarly, at cutoff value of 61, peritumoral MVD predicted LN metastasis with sensitivity of 94% and specificity of 89%. The 5-year survival was 79 and 77% for those with low intratumoral and peritumoral MVD, respectively, as compared to 41 and 39% for those with high intratumoral and peritumoral MVD, respectively (P < 0.05).

CONCLUSIONS: Higher intratumoral and peritumoral MVD predicts cancer progression in patients with PSCC. Patients with an intratumoral MVD of 54 and peritumoral MVD of 61 have lymph node metastasis with a high sensitivity and specificity. The overall 5-year survival of patients is poor in high intratumoral or peritumoral MVD.