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Assessing the density of lymph node metastasis in various inguinal regions of penile cancer using the nine‑section method: A prospective study

  • Authors:
    • Chen Hu
    • Longguo Dai
    • Hongyi Wu
    • Yu Bai
    • Jun Li
    • Haiyang Jiang
    • Haoli Yin
    • Ying Bi
    • Wenzhao Wu
    • Ruiqian Li
    • Hong Shi
  • View Affiliations / Copyright

    Affiliations: State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, Yunnan 650500, P.R. China, Department of Urology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Peking University Cancer Hospital Yunnan, Kunming, Yunnan 650118, P.R. China
    Copyright: © Hu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 222
    |
    Published online on: April 8, 2026
       https://doi.org/10.3892/ol.2026.15577
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Abstract

Inguinal lymph node (ILN) metastasis in patients diagnosed with penile squamous cell cancer (PSCC) is a notable factor that leads to a substantial decrease in patient survival rates. Current guidelines differ in terms of the scope of radical ILN dissection (rILND) and a unified consensus has not yet been reached. The present study aimed to optimize the standardized surgical lymph node dissection boundaries for rILND and to explore the rILND range suitable for the population. This prospective study included 26 patients with PSCC who underwent rILND. Anatomically, the ILNs were divided into 9 regions centered on the saphenofemoral junction and the bifurcation of the great saphenous vein, and a detailed pathological examination was performed. Positive ILNs were mainly concentrated in regions 1 and 2; however, 9.1% of positive ILNs were found in the surrounding regions 3, 4 and 7. Region 1 had the highest lymph node metastatic density among all regions. In patients with single or regional lymph node metastasis, positive ILNs were detected in regions 1, 2, 5 and 8. The pathway of ILN metastasis may first invade regions 1, 2, 5 and 8 and subsequently spread to other areas. Region 1 positivity was preliminarily associated with inferior disease‑free survival but was not associated with overall survival. A detailed distribution map of ILNs with metastatic density using the nine‑section method was established and an optimized dissection range was formed including region 1. This study was registered with the Chinese Clinical Trial Registry under clinical trial number ChiCTR2200064529 (registration date, 2022‑10‑11).
View Figures

Figure 1

Surgical boundaries of ILND and the
regional division of ILNs according to the nine-section method. (A)
The area inside the purple line represents the Campbell ILND range.
The area inside the red line represents the NCCN radical ILND
range. The area inside the blue line represents the NCCN modified
ILND range. The area inside the black line represents the
nine-section dissection range. (B) The nine-section regional
division: Line ‘a’ is located 1 cm medial to the saphenofemoral
junction, line ‘b’ is located 1 cm lateral to the saphenofemoral
junction, line ‘c’ is at the midpoint level of the inguinal
ligament and line ‘d’ is at the lower edge of the femoral triangle
below the saphenofemoral junction. (C) The actual division
according to the nine-section method. ILN, inguinal lymph node;
ILND, ILN dissection; NCCN, National Comprehensive Cancer
Network.

Figure 2

Proportions, quantities and lymph node
metastasis densities of dissected or positive ILNs. (A) Total
number and proportion of dissected lymph nodes. (B) Proportion of
patients with positive lymph nodes. (C) Lymph node metastasis
density. (D) The ILN dissection range recommended in this study
(dashed black outlined area). ILN, inguinal lymph node.

Figure 3

Distribution of single-positive and
first-station positive ILNs. (A) Single positive ILN distribution.
(B) Single positive region distribution. (C) Lymphatic drainage
patterns of ILNs in penile squamous cell cancer. Blue arrows
represent the areas where the first-station positive lymph nodes
may occur, with thicker lines indicating a higher probability. ILN,
inguinal lymph node.

Figure 4

K-M analyses of lymph node-negative,
lymph node-positive, region 1 lymph node-negative and region 1
lymph node-positive statuses. OS, overall survival; DFS,
disease-free survival; K-M, Kaplan-Meier; HR, hazard ratio; Ci,
confidence interval; ILN, inguinal lymph node.
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Copy and paste a formatted citation
Spandidos Publications style
Hu C, Dai L, Wu H, Bai Y, Li J, Jiang H, Yin H, Bi Y, Wu W, Li R, Li R, et al: Assessing the density of lymph node metastasis in various inguinal regions of penile cancer using the nine‑section method: A prospective study. Oncol Lett 31: 222, 2026.
APA
Hu, C., Dai, L., Wu, H., Bai, Y., Li, J., Jiang, H. ... Shi, H. (2026). Assessing the density of lymph node metastasis in various inguinal regions of penile cancer using the nine‑section method: A prospective study. Oncology Letters, 31, 222. https://doi.org/10.3892/ol.2026.15577
MLA
Hu, C., Dai, L., Wu, H., Bai, Y., Li, J., Jiang, H., Yin, H., Bi, Y., Wu, W., Li, R., Shi, H."Assessing the density of lymph node metastasis in various inguinal regions of penile cancer using the nine‑section method: A prospective study". Oncology Letters 31.6 (2026): 222.
Chicago
Hu, C., Dai, L., Wu, H., Bai, Y., Li, J., Jiang, H., Yin, H., Bi, Y., Wu, W., Li, R., Shi, H."Assessing the density of lymph node metastasis in various inguinal regions of penile cancer using the nine‑section method: A prospective study". Oncology Letters 31, no. 6 (2026): 222. https://doi.org/10.3892/ol.2026.15577
Copy and paste a formatted citation
x
Spandidos Publications style
Hu C, Dai L, Wu H, Bai Y, Li J, Jiang H, Yin H, Bi Y, Wu W, Li R, Li R, et al: Assessing the density of lymph node metastasis in various inguinal regions of penile cancer using the nine‑section method: A prospective study. Oncol Lett 31: 222, 2026.
APA
Hu, C., Dai, L., Wu, H., Bai, Y., Li, J., Jiang, H. ... Shi, H. (2026). Assessing the density of lymph node metastasis in various inguinal regions of penile cancer using the nine‑section method: A prospective study. Oncology Letters, 31, 222. https://doi.org/10.3892/ol.2026.15577
MLA
Hu, C., Dai, L., Wu, H., Bai, Y., Li, J., Jiang, H., Yin, H., Bi, Y., Wu, W., Li, R., Shi, H."Assessing the density of lymph node metastasis in various inguinal regions of penile cancer using the nine‑section method: A prospective study". Oncology Letters 31.6 (2026): 222.
Chicago
Hu, C., Dai, L., Wu, H., Bai, Y., Li, J., Jiang, H., Yin, H., Bi, Y., Wu, W., Li, R., Shi, H."Assessing the density of lymph node metastasis in various inguinal regions of penile cancer using the nine‑section method: A prospective study". Oncology Letters 31, no. 6 (2026): 222. https://doi.org/10.3892/ol.2026.15577
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