Introduction

Penile cancer is an uncommon disease with little level I evidence to guide therapy. The NCCN guidelines advocate a lymph node dissection (LND) with consideration of perioperative chemotherapy (CT) for all lymph node positive (LN+) penile cancer (PC) pts. Using a large national cancer registry, we assessed temporal trends in utilization of CT for LN+M0 PC, and evaluated outcomes between those who did (LND+) and did not (LND-) receive a LND and/or chemotherapy (CT+ vs. CT-).

Methods

The National Cancer Database (NCDB) was queried for all non-metastatic PC patients with LN+ squamous cell carcinoma of the penis from 2004-2014. Temporal trends were assessed using Cochran-Armitage tests. Adjusting for patient, clinical, and tumor characteristics, multivariable logistic models were used to examine the association between clinicopathologic characteristics and receipt of CT. Kaplan Meier analyses with log-rank tests and multivariable Cox regressions were used to analyze overall survival (OS).

Results

Of 1123 pts identified, 750 (67%) underwent a LND. Receipt of chemotherapy was similar in both LND+ (40%) and LND- (42%) pts (p=0.53). From 2004-2014, the overall utilization of systemic therapy significantly increased (38% vs. 48%. p=0.0009). However, only 53% of N3 patients received CT (N1 31%, N2 40%). Following adjustment, older patients (76 + years: OR 0.34 [CI 0.19-0.59], p=0.0002) were less likely to receive CT, while N2 (OR 1.62 [CI 1.16-2.27], p=0.005) and N3 (OR 2.32 [CI 1.67-3.22], p<0.0001) pts were more likely to receive CT. High volume centers (≥ 4 cases of PC/year; 29% of all LN+ cases) delivered less CT (OR 0.69 [CI 0.48-1.00], p=0.047). OS varied from 14.9 mo in the LND-/CT- group to 42.6 mo in the LND+/CT+ group. On multivariable analysis, receipt of CT was not associated with OS (HR 0.95 [CI 0.77-1.19], p=0.67).

Conclusions

In hospitals reporting to the NCDB, only 67% of LN+ PC pts receive a LND. While CT utilization has increased since 2004, rates remain low, even for N3 pts for whom the NCCN clearly recommends systemic therapy. Surprisingly, high volume centers were less likely to deliver CT for LN+ patients. Receipt of CT does not appear to affect OS, which likely reflects the aggressive natural history of PC. Nonetheless, these data highlight opportunities to improve adherence to guideline-recommended care.

Funding

none