PURPOSE: Management of squamous cell carcinoma of the penis (SCCp) has changed over the last decades in favor of penile sparing surgery.
Our purpose was to assess whether penile sparing therapies were increasingly applied in our SCCp cohort over time and whether penis sparing affected five-year cancer-specific survival (CSS).
MATERIALS AND METHODS: Records of 1000 patients treated between 1956 and 2012 were reviewed, 859 patients with invasive tumors were eligible for analysis. Tumors were staged according to the 2009 TNM-classification. Binary logistic regression was used to assess penile preservation versus amputation in time. CSS was analyzed using Kaplan-Meier method and multivariable Cox proportional hazards model; a competing risk analysis was used for local recurrence.
RESULTS: Over time, significantly less penile amputations were carried out. The 5-year cumulative incidence of local recurrences as first event after penis preservation was observed in 27% (95%-CI:23-32), while after (partial) penectomy it was 3.8% (95%-CI:2.3-6.2, Gray's test p< 0.0001). Patients treated with penile preservation showed no significant difference in survival compared to patients treated with (partial) amputation after adjusting for relevant covariables. Factors associated with CSS were pathological T-stage, pathological N-stage and lymphovascular invasion on multivariable analysis. In the penile preserving treated group, local recurrence as a time dependent variable in a Cox model was not associated with CSS (HR0.52, 95%-CI:0.21-1.24, p=0.13).
CONCLUSIONS: Significantly more penile preserving therapies were performed in more recent years. Although patients treated with penile preservation experienced more local recurrences, 5-year CSS was not jeopardized.
Written by:
Djajadiningrat RS, van Werkhoven E, Meinhardt W, van Rhijn BW, Bex A, van der Poel HG, Horenblas S. Are you the author?
Departments of Urology, The Netherlands Cancer Institute Amsterdam, The Netherlands; Departments of Biometrics, The Netherlands Cancer Institute Amsterdam, The Netherlands; Departments of Urology, The Netherlands Cancer Institute Amsterdam, The Netherlands.
Reference: J Urol. 2013 Dec 24. pii: S0022-5347(13)06140-5.
doi: 10.1016/j.juro.2013.12.038
PubMed Abstract
PMID: 24373799
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