Login to Access Video or Poster Abstract: MP92-14
Sources of Funding: none

Introduction

Penile cancer is a highly curable malignancy when clinically localized. Advanced stage is associated with significantly worse survival due to a lack of effective systemic therapies. As penile cancer is rare in the United States, we sought to explore factors associated with stage at presentation and survival using a population-level database.

Methods

The National Cancer Database (NCDB) was queried from 2004-2014 for patients diagnosed with penile squamous cell carcinoma (SCC). AJCC clinical stage grouping at presentation was correlated with patient age, race, insurance status, income/education level of patient zip code, distance from hospital, Charlson/Deyo comorbidity score, urban vs. rural hospital location, and geographic region. Overall survival was stratified by AJCC clinical stage grouping and dichotomized into localized vs. non-localized disease at presentation. Cox multivariate regression survival analysis was performed to determine predictors of survival.

Results

11,112 cases of penile SCC were identified; stage 0 (n=2258), stage I (n=2325), stage II (n=1313) stage III (n=632) and stage IV (n=571). Multivariate logistic regression (Table) for localized (stage 0-II) vs. non-localized disease (stage III-IV) identified that minority (black and Hispanic) patients and those with non-private insurance were independently associated with an increased risk of being diagnosed with non-localized penile SCC. Overall survival was inversely proportional with stage at presentation (Figure). Cox multivariate regression analysis for overall survival demonstrated that AJCC stage (stage 0 - reference; stage I HR 1.53; II HR 2.24; III HR 3.36; IV HR 8.73, p<0.01), lower income level, black race (HR 1.22, p=0.008), and lack of private insurance (HR 1.41-1.80 [depending on type of insurance], p<0.05) were associated with decreased survival.

Conclusions

Minority patients and those with non-private insurance are significantly more likely to present with higher stage, non-localized penile SCC. Predictably survival was strongly associated with stage at presentation; additionally we found black patients, those from lower income levels, and those without private insurance were also at increased risk of dying during follow-up - independent of stage at presentation.

Funding

none