Predictors of local recurrence and its impact on survival after glansectomy for penile cancer: time to challenge the dogma?
Aged
Carcinoma, Squamous Cell
/ secondary
Humans
Kaplan-Meier Estimate
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Grading
Neoplasm Invasiveness
Neoplasm Recurrence, Local
/ pathology
Neoplasm Staging
Organ Sparing Treatments
Penile Neoplasms
/ pathology
Penis
/ surgery
Proportional Hazards Models
Retrospective Studies
Risk Factors
Survival Rate
high-grade
local recurrence
organ-sparing surgery
pT-stage
penile cancer
risk factors
survival
Journal
BJU international
ISSN: 1464-410X
Titre abrégé: BJU Int
Pays: England
ID NLM: 100886721
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
pubmed:
13
11
2020
medline:
21
9
2021
entrez:
12
11
2020
Statut:
ppublish
Résumé
To identify predictive pathological factors for local recurrence (LR) and to study the impact of LR on survival in patients treated with glansectomy for penile squamous cell carcinoma (pSCC). We retrospectively studied patients treated with glansectomy at international, high-volume reference centres. We analysed histopathological predictors of LR, stratified patients into risk groups based on the number of risk factors present, and studied the impact of LR on survival outcomes using Kaplan-Meier survival analysis and stepwise Cox proportional hazards regression models. Subsequently, we performed sensitivity analyses excluding margin-positive cases, pT3 disease, and cN+ disease, or all of these factors. Across nine institutions, 897 patients were included, of whom 94 experienced LR. On multivariable analysis, presence of high-grade disease and pT3 stage were independent predictors of LR. LR-free survival rates significantly differed according to the number of risk factors present, with a hazard ratio (HR) of 1.90 (95% confidence interval [CI] 1.17-3.07; P = 0.01) for the intermediate-risk group (one risk factor) and 6.11 (95% CI 3.47-10.77; P < 0.001) for the high-risk group (two risk factors), using the low-risk group (no risk factors) as reference. Patients who experienced LR had significantly worse overall survival (OS; HR 2.89, 95% CI 2.02-4.14; P < 0.001) and cancer-specific survival (CSS; HR 5.64, 95% CI 3.45-9.22; P < 0.001). LR (HR 3.82, 95% CI 2.14-6.8; P < 0.001), lymphovascular invasion and cN status were significant predictors of decreased CSS. LR remained a strong predictor of both OS and CSS in all sensitivity analyses. Pathological T3 stage and presence of high-grade disease were independent histopathological predictors of LR after glansectomy for primary pSCC, which allowed risk stratification into three groups with significantly different risk of developing LR. Additionally, LR is related to poor OS and CSS, indicating that LR is a manifestation of underlying aggressive disease and clearly challenging the dogma of using organ-sparing surgery whenever possible since survival is unaffected by higher LR rates.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
606-613Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 The Authors BJU International © 2020 BJU International Published by John Wiley & Sons Ltd.
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