Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
Clin Genitourin Cancer. 2018 Apr;16(2):e383-e389. doi: 10.1016/j.clgc.2017.09.004. Epub 2017 Sep 8.
The purpose of this study was to analyze contemporary trends and predictors in the use of organ-sparing treatment (OST) for low-stage invasive penile tumors as well as to ascertain its impact on overall mortality (OM) in those with high-risk (pT2) disease.
The National Cancer Data Base was queried for patients with clinically nonmetastatic penile cancer and available pathologic tumor (pT) and treatment data from 1998 to 2012. Independent predictors for performance of OST were analyzed. Multivariable Cox proportional hazard regression was used to identify factors of OM in a subset of patients with pT2 disease.
A total of 4231 patients with ≤ pT2cN0cM0 primary penile cancer were identified over a median follow-up of 39.6 months. Approximately 49% of patients received OST over the study period (P = .009). Older age, Hispanic ethnicity, urban counties, academic facilities, and pT2 disease were negative predictors for OST (all P < .05), whereas grade and years of diagnosis where associated with increased performance (P < .01). In subgroup analysis of pT2 patients, older age, black race, comorbidity, node status, and grade were associated with higher OM (all P < .05). When compared with radical penectomy, partial penectomy was associated with decreased OM (hazard ratio, 0.67; 95% confidence interval, 0.52-0.87; P = .002), whereas organ-sparing did not affect survival (hazard ratio, 0.83; 95% confidence interval, 0.52-1.31; P = .419) in these patients.
Ethnic and socioeconomic differences exist in the local management of penile tumors. No impact on OM was observed for those with high-risk cases treated with organ-sparing at intermediate follow-up. More studies are needed to evaluate oncologic efficacy of organ-sparing in carefully selected invasive penile tumors.
本研究旨在分析低分期浸润性阴茎肿瘤保器官治疗（OST）的当代趋势和预测因素，并确定其对高危（pT2）疾病患者总体死亡率（OM）的影响。
从 1998 年至 2012 年，国家癌症数据库（National Cancer Data Base）对临床无转移性阴茎癌患者和可获得的病理肿瘤（pT）和治疗数据进行了查询。分析了进行 OST 的独立预测因素。多变量 Cox 比例风险回归用于识别 pT2 疾病亚组患者 OM 的因素。
在中位随访 39.6 个月期间，共确定了 4231 例患有≤pT2cN0cM0 原发性阴茎癌的患者。在研究期间，约有 49%的患者接受了 OST（P=0.009）。年龄较大、西班牙裔、城市县、学术机构和 pT2 疾病是 OST 的负预测因素（均 P<0.05），而分级和诊断年限与 OST 呈正相关（均 P<0.01）。在 pT2 患者的亚组分析中，年龄较大、黑种人、合并症、淋巴结状态和分级与更高的 OM 相关（均 P<0.05）。与根治性阴茎切除术相比，部分阴茎切除术与 OM 降低相关（风险比，0.67；95%置信区间，0.52-0.87；P=0.002），而保器官治疗对这些患者的生存没有影响（风险比，0.83；95%置信区间，0.52-1.31；P=0.419）。
在阴茎肿瘤的局部管理中存在种族和社会经济差异。在中期随访中，高危病例接受保器官治疗对 OM 没有影响。需要更多的研究来评估精心选择的浸润性阴茎肿瘤保器官治疗的肿瘤学疗效。
