Original article
15 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

https://doi.org/10.1016/j.urolonc.2016.06.019Get rights and content

Highlights

  • Penile cancer remains a rare disease in the United States and its understanding may be limited by the uncommon nature of the malignancy.

  • Penile-sparing surgery for early stage disease and the use of chemotherapy for metastatic disease are becoming more commonly utilized over the last 15 years.

  • Further work is needed to define clinical and nonclinical factors associated with treatment approaches for patients with penile cancer.

Abstract

Background

Penile cancer remains a rare disease in the United States, and its understanding may be limited by the uncommon nature of the malignancy. We sought to describe recent penile cancer treatment patterns using the National Cancer Data Base.

Methods

A retrospective review of data obtained from the National Cancer Data Base from 1998 to 2012 was performed. We obtained demographic information and therapeutic approaches within the following2 clinical scenarios: performance of partial penectomy for early stage disease (clinical Ta–T2) and the use of chemotherapy for metastatic disease. Multivariate logistic analysis was performed.

Results

A total of 2,677 patients presented with early stage penile carcinoma. The proportion receiving partial penectomy increased from 74% in 1998 to 2000 to 80% in 2010 to 2012 (P<0.001). Partial penectomy was more common in the elderly (age>80, odd ratios [OR] = 1.53, 95% CI: 1.05–2.23), young (age<50, OR = 1.46, 95% CI: 1.02–2.07), and in African Americans (OR = 1.45, 95% CI: 1.00–2.12). Increasing tumor size was significantly associated with decreased likelihood of receiving partial penectomy. Of those presenting with metastatic disease (n = 819), use of chemotherapy increased over the time period from 39% receiving chemotherapy in 1998 to 2000 to 49% in 2010 to 2012 (P<0.03). Patients least likely to receive chemotherapy were older and with higher Comorbidity score (both P<0.05), African American (OR = 0.46, 95% CI: 0.30–0.73), and living≥50 miles from the nearest treatment hospital (OR = 0.37, 95% CI: 0.25–0.55).

Conclusions

Penile-sparing surgery for early stage disease and the use of chemotherapy for metastatic disease are becoming more commonly utilized over the past several years. Further work is needed to define clinical and nonclinical factors associated with the treatment.

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

References (28)

  • R. Siegel et al.

    Cancer statistics, 2013

    CA Cancer J Clin

    (2013)
  • P.E. Clark et al.

    Penile cancer: clinical practice guidelines in oncology

    J Natl Compr Canc Netw

    (2013)
  • L.C. Pagliaro et al.

    Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy for metastatic penile cancer: a phase II study

    J Clin Oncol

    (2010)
  • M.A. Hoffman et al.

    Squamous cell carcinoma of the penis and microscopic pathologic margins: how much margin is needed for local cure?

    Cancer

    (1999)
  • Cited by (0)

    Data provided by American College of Surgeons: National Cancer Data Base.

    View full text