National Trends and Predictors of Locally Advanced Penile Cancer in the United States (1998-2012)

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BackgroundWe analyzed the trends in presentation of squamous cell carcinoma (SCC) of the penis and determined the socioeconomic predictors for locally advanced (cT3-cT4) disease in the United States.Patient and MethodsThe National Cancer Database was queried for patients with clinically nonmetastatic penile SCC and staging available from 1998 to 2012. Temporal trends per tumor stage were evaluated, and a multivariable logistic regression model was used to identify predictors for advanced presentation during the study period.ResultsA total of 5767 patients with stage ≤ T1-T2 (n = 5423) and T3-T4 (n = 344) disease were identified. Increasing trends were noted in all stages of penile SCC with a greater proportion of advanced cases over time (P = .001). Significant predictors of advanced presentation were age > 55 years, the presence of comorbidities, and Medicaid or no insurance (P < .05 for all).ConclusionMore penile SCC is being detected in the United States. Our results have demonstrated older age, presence of comorbidities, and Medicaid or no insurance as potential barriers to early access of care in the male population. Understanding the current socioeconomic gaps could help guide targeted interventions in vulnerable populations.Micro-AbstractPenile squamous cell carcinoma (SCC) is rare in the Western world. We analyzed trends in presentation using the National Cancer Database. Of 5767 patients, cT1 was the most common presentation (40.7%), while 5.9% had locally-advanced disease (cT3-cT4) with increasing proportion over time (P =.001). Predictors of advanced presentation were age, comorbidity, and insurance status (P < .05 for all). More penile SCC is being diagnosed in the United States with the proportion of those with advanced disease increasing over time. Whether HPV vaccination in the male population will cause correspondent decreases in HPV-related precancerous lesions remains to be seen.

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