Patterns of Regional Lymphadenectomy for Clinically Node-negative Patients With Penile Carcinoma: Analysis From the National Cancer Database From 1998 to 2012

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Abstract

Micro-Abstract

Few studies report trends of regional lymphadenectomy (rND) for patients with penile cancer without clinical adenopathy. Using data from a nationwide cancer registry, 7340 cN0M0 patients were identified, of which 29.5% underwent rND during the study period. Available follow-up in 1919 patients demonstrated an increase in early performance of rND, likely owing to referral patterns from community to comprehensive and academic programs. African American patients and those over age 75 years were significantly less likely to receive rND, whereas early rND was associated with improved survival outcomes for these patients.

Purpose:

Evidence supports upfront regional lymphadenectomy (rND) when primary penile tumors exhibit high-risk features and negative inguinal adenopathy (cN0). We sought to analyze trends in the utilization of early rND as well as assess factors associated with its use and survival outcomes using a nationwide cancer registry database.

Patient and Methods:

The National Cancer Database was queried for patients with clinically nonmetastatic penile carcinoma and available nodal status who underwent rND from 1998 to 2012. Temporal trends in the utilization of early rND for those with cN0 disease were analyzed, and a multivariable logistic regression model was used to identify predictors for receiving rND. Survival analysis based on rND status was performed using the Kaplan-Meier method and Cox proportional hazard regression.

Results:

From 1919 patients with available clinicopathologic variables, performance of early rND was documented in 377 (19.6%) patients with an increase in utilization over time (P = .001). The increase was driven by academic and comprehensive cancer programs compared with community programs (P < .001). Positive predictors were treatment facility, clinical tumor stage, and grade (all P < .05). African American patients (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.33-0.86; P = .01) and those aged > 75 years (OR, 0.42; 95% CI, 0.26-0.68; P < .001) were significantly less likely to receive rND. Early rND was associated with improved overall survival (hazard ratio [HR], 0.67; 95% CI, 0.52-0.87; P = .003).

Conclusion:

There was increased use of early lymphadenectomy for patients with cN0 penile cancer driven by comprehensive and academic cancer programs. The study demonstrated demographic and socioeconomic differences that can help identify barriers to care for patients with penile cancer in the United States.

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