Introduction

Penile cancer (PC) is an uncommon disease with little level I evidence to guide therapy. The NCCN guidelines advocate for inguinal lymph node dissection (LND) for all patients with pT2 disease. Using a large national cancer registry, we assessed temporal trends in LND performance for patients with T2 disease, and evaluated survival outcomes between those who underwent LND and those who did not.

Methods

The National Cancer Database (NCDB) was queried for all non-metastatic PC patients with T2 squamous cell carcinoma of the penis from 2004-2014. Temporal trends for receipt of LND were assessed using Cochran-Armitage tests. , We used multivariable logistic regression models to examine the association between demographic and clinicopathologic characteristics and receipt of LND. Kaplan Meier analyses with log-rank tests and multivariable Cox regressions with time-varying covariates were used to assess overall survival (OS).

Results

A total of 1699 patients met inclusion criteria, of which 617 (36.3%) underwent LND. LND rates increased significantly from 2004 to 2014 (27 versus 46%, p<0.001). Significant differences in rates of LND were observed with regards to receipt of radiation (59% in treated vs 34% in not treated, p<0.001) chemotherapy (69% in treated vs 33% in not treated, p< 0.001), age (53% for ?50 yrs vs 22% for >70 yrs, p<0.001), and facility type (21% at community hospitals vs 48% at academic centers, p < 0.001). Following adjustment, the likelihood of receiving of LND decreased with increasing age (71 + year OR 0.30 [CI 0.23-0.64]), and increased with year of diagnosis (OR 2.30 for 2014 vs 2004[CI 1.19-4.43]) and treatment in an academic/research facility (OR 2.92 [CI 1.84-4.62] ). In survival analyses, patients receiving LND had a significantly longer median overall survival (113.9 months vs. 46.2 months, p<0.001). The survival benefit of LND was stronger 2+ years from surgery (HR 0.62 [CI 0.44-0.89]) compared 0-2 years (HR 0.85 [CI 0.68-1.06]) (see figure 1).

Conclusions

In hospitals reporting to NCDB, the rate of LND for patients with T2 penile cancer was only 36.3%. The observed survival benefit indicates that LND utilization is an important quality metric in patients with invasive penile cancer.

Funding

none