Abstract
Purpose
Evidence supports upfront regional lymphadenectomy (rND) when primary penile tumors
exhibit high-risk features and negative inguinal adenopathy (cN0). We sought to analyze
trends in the utilization of early rND as well as assess factors associated with its
use and survival outcomes using a nationwide cancer registry database.
Patient and Methods
The National Cancer Database was queried for patients with clinically nonmetastatic
penile carcinoma and available nodal status who underwent rND from 1998 to 2012. Temporal
trends in the utilization of early rND for those with cN0 disease were analyzed, and
a multivariable logistic regression model was used to identify predictors for receiving
rND. Survival analysis based on rND status was performed using the Kaplan-Meier method
and Cox proportional hazard regression.
Results
From 1919 patients with available clinicopathologic variables, performance of early
rND was documented in 377 (19.6%) patients with an increase in utilization over time
(P = .001). The increase was driven by academic and comprehensive cancer programs compared
with community programs (P < .001). Positive predictors were treatment facility, clinical tumor stage, and grade
(all P < .05). African American patients (odds ratio [OR], 0.53; 95% confidence interval
[CI], 0.33-0.86; P = .01) and those aged > 75 years (OR, 0.42; 95% CI, 0.26-0.68; P < .001) were significantly less likely to receive rND. Early rND was associated with
improved overall survival (hazard ratio [HR], 0.67; 95% CI, 0.52-0.87; P = .003).
Conclusion
There was increased use of early lymphadenectomy for patients with cN0 penile cancer
driven by comprehensive and academic cancer programs. The study demonstrated demographic
and socioeconomic differences that can help identify barriers to care for patients
with penile cancer in the United States.
Keywords
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References
- Trends in survival of patients diagnosed with male genital cancers in the Nordic countries, 1964-2003 followed up until the end of 2006.Acta Oncol. 2010; 49: 644-654
- Long-term trends in incidence, survival and mortality of primary penile cancer in England.Cancer Causes Control. 2013; 24: 2169-2176
- EAU guidelines on penile cancer: 2014 update.Eur Urol. 2015; 67: 142-150
- Size of metastasis in the sentinel node predicts additional nodal involvement in penile carcinoma.J Urol. 2006; 176: 105-108
- Penile cancer: Clinical Practice Guidelines in Oncology.J Natl Compr Canc Netw. 2013; 11: 594-615
- Racial and economic disparities in the treatment of penile squamous cell carcinoma: results from the National Cancer Database.Urol Oncol. 2016; 34: 122e9-122e15
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Management of penile cancer.Urology. 2016; 96: 15-21
- Cancer of the penis.Crit Rev Oncol Hematol. 2005; 53: 165-177
- Penis conserving treatment for T1 and T2 penile carcinoma: clinical implications of a local recurrence.J Urol. 2006; 176 (discussion: 580): 575-580
- Cancers, precancers, and pseudocancers on the male genitalia. A review of clinical appearances, histopathology, and management.J Dermatol Surg Oncol. 1980; 6: 1027-1035
- Penile sparing surgery for penile cancer-does it affect survival?.J Urol. 2014; 192: 120-125
- Lymph node metastases and prognosis in penile cancer.Chin J Cancer Res. 2012; 24: 90-96
- Inguinal recurrence following therapeutic lymphadenectomy for node positive penile carcinoma: outcome and implications for management.J Urol. 2011; 185: 888-893
- Prognostic significance of extranodal extension in patients with pathological node positive penile carcinoma.J Urol. 2010; 184: 1347-1353
- EAU penile cancer guidelines 2009.Eur Urol. 2010; 57: 1002-1012
- Penile cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2013; 24: vi115-vi124
- pT1 penile squamous cell carcinoma: a clinicopathologic study of 56 cases treated by CO2 laser therapy.Anal Quant Cytol Histol. 2009; 31: 153-160
- Centralization of Penile Cancer Management in the United States: A Combined Analysis of the American Board of Urology and National Cancer Data Base.Urology. 2016; 90: 82-88
- Squamous cell carcinoma of the penis: evaluation of data from the surveillance, epidemiology, and end results program.Cancer. 2004; 101: 1357-1363
- The development of a supraregional network for the management of penile cancer.Ann R Coll Surg Engl. 2012; 94: 204-209
Article info
Publication history
Published online: April 25, 2017
Accepted:
April 14,
2017
Received in revised form:
April 7,
2017
Received:
February 22,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
