Urologic Oncology: Seminars and Original Investigations
Original article15 Years of penile cancer management in the United States: An analysis of the use of partial penectomy for localized disease and chemotherapy in the metastatic setting
Introduction
Penile carcinoma (PC) is a rare disease in the United States with approximately 1,500 new diagnoses and over 300 deaths annually [1]. PC often displays a propensity for locoregional spread to lymph nodes and metastatic deposition to distant sites [2]. In fact, for those with advanced disease already involving the pelvic lymph nodes, 5-year survival may be as low as 10% [3]. Owing to the clinical rarity of the disease, the ability to comprehensively study PC in the United States is limited and most of the available literature is based on small-sized, single-institution retrospective reviews. Thus, the aggressive clinical nature combined with the rarity of the condition may contribute, in part, to a lack of available data to study the disease.
Multiple management strategies are available for men with PC. Increasingly, the surgical approach to the primary tumor has focused on penile preservation advocating for broader use of partial penectomy as opposed to radical penectomy [4]. There are now increasing options for management of metastatic disease with the use of various chemotherapy regimens resulting in improved response rates and survival [5]. Whether these strategies have been adopted by the general urology practice in the United States is unknown. To better understand the use of partial penectomy and chemotherapy in PC, we used the data provided by the National Cancer Data Base (NCDB).
Section snippets
Study sample
This is a retrospective review based on a cohort created from the Commission on Cancer׳s NCDB from 1998 to 2012. The sample is de-identified patient level data that are Health Insurance Portability and Accountability Act compliant, thus qualified for a waiver of institutional review board approval.
We analyzed patient characteristics, demographic information, and therapeutic approaches within 2 clinical scenarios—(1) use of partial penectomy for early stage (clinical Ta–T2 disease) and (2) use
Results
Table 1 shows demographic, clinical, and facility characteristics stratified by the treatment parameters of the 2 analysis cohorts. From 1998 to 2010, a total of 2,677 patients who underwent surgery for early stage disease were identified. The proportion receiving partial penectomy increased from 74% in 1998 to 2000 to 80% in 2010 to 2012 (P<0.001). Compared to those aged 50 to 59, partial penectomy was more common in the old (age>80, odd ratios [OR] = 1.53, 95% CI: 1.05–2.23) and young
Conclusions
In this work, we demonstrate the evolving landscape in the management of PC over the past 10 years. Among our findings, we have found an increased rate of utilization in partial penectomy for early stage disease. Several factors may account for this observation. Traditional approaches to penile cancer have focused upon radical penectomy for optimal oncologic control. However, recent data have indicated that partial penectomy may obtain adequate local control with comparable survival rates to
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Cited by (0)
Data provided by American College of Surgeons: National Cancer Data Base.