Open Access Highly Accessed Research article

Elevated C-reactive protein values predict nodal metastasis in patients with penile cancer

Andreas Al Ghazal1, Sandra Steffens2*, Julie Steinestel1, Rieke Lehmann2, Thomas J Schnoeller1, Anna Schulte-Hostede1, Gerd Wegener3, Florian Jentzmik1, Mark Schrader1, Markus A Kuczyk2 and Andres J Schrader1

Author Affiliations

1 Department of Urology, Ulm University Medical Center, Ulm, Germany

2 Department of Urology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany

3 Cancer Center, Hannover Medical School, Hannover, Germany

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BMC Urology 2013, 13:53  doi:10.1186/1471-2490-13-53

Published: 22 October 2013



The nodal status is a strong predictor for cancer specific death in patients with penile carcinoma, and the C-reactive protein (CRP) level at diagnosis has recently been shown to be associated with poor clinical outcome in various solid malignancies. Therefore, this retrospective study was performed to evaluate the association between preoperative CRP levels and the incidence of nodal metastasis in patients with squamous cell carcinoma (SCC) of the penis.


The analysis included 51 penile cancer patients who underwent either radical or partial penectomy for pT1-4 penile cancer between 1990 and 2010. The nodal status was correlated with patient and tumor specific characteristics.


Sixteen (31%) patients had lymph node metastasis at the time of penile cancer surgery. Nodal status was associated with tumor stage but did not correlate significantly with tumor grade. In contrast, high presurgical CRP levels were significantly associated with the diagnosis of nodal involvement (pā€‰=ā€‰0.04). The optimal CRP cut-off value to predict lymph node metastasis was set at 20 mg/l based on ROC analysis.


Since a high preoperative serum CRP level was closely correlated with nodal disease, it could be used as an additional marker to help identify patients with penile cancer who may benefit from inguinal lymph node dissection.

Penile cancer; Biomarker; C-reactive protein; Nodal disease; Prognosis; Survival