Chang Edward K, Sekar Rishi R, Holt Sarah K, Gore John L, Wright Jonathan L, Nyame Yaw A
Department of Urology, University of Washington School of Medicine, Seattle, Washington.
Urol Pract. 2021 May 1;8(3):348-354. doi: 10.1097/UPJ.0000000000000214.
Prior studies of mixed insurance populations have demonstrated poor adherence to surgical standard of care (SOC) for penile cancer. We used data from the Surveillance, Epidemiology and End Results (SEER) cancer registry linked to Medicare to calculate SOC adherence to surgical treatment of penile cancer in insured men over the age of 65, focusing on potential social and racial disparities.
This is an observational analysis of patients with T2-4 penile cancer of any histologic subtype without metastasis in the SEER-Medicare database (2004-2015). SOC was defined as penectomy (partial or radical) with bilateral inguinal lymph node dissection (ILND) based on the National Comprehensive Cancer Network guidelines. We calculated proportions of those receiving SOC and constructed multivariate models to identify factors associated with receiving SOC.
A total of 447 men were included. Of these men, 22.1% (99/447) received SOC while 18.8% (84/447) received no treatment at all. Only 23.3% (104/447) had ILND while 80.9% (362/447) underwent total or partial penectomy. Race and socioeconomic status (SES) were not associated with decreased SOC. Increasing age (OR 0.93, 95%CI:0.89-0.96), Charlson Comorbidity Index score ≥ 2 (OR 0.53, 95%CI:0.29-0.97), and T3-T4 disease (OR 0.34, 95%CI:0.18-0.65) were associated with not receiving SOC on adjusted analysis.
Rates of SOC are low among insured men 65 years of age or older with invasive penile cancer, regardless of race or SES. This finding is largely driven by low rates of ILND. Strategies are needed to overcome barriers to SOC treatment for men with invasive penile cancer.
先前对混合保险人群的研究表明，阴茎癌患者对手术标准治疗（SOC）的依从性较差。我们利用与医疗保险相关的监测、流行病学和最终结果（SEER）癌症登记数据，计算65岁以上参保男性阴茎癌手术治疗的SOC依从性，重点关注潜在的社会和种族差异。
这是一项对SEER - 医疗保险数据库（2004 - 2015年）中任何组织学亚型的T2 - 4期无转移阴茎癌患者的观察性分析。根据美国国立综合癌症网络指南，SOC定义为阴茎切除术（部分或根治性）加双侧腹股沟淋巴结清扫术（ILND）。我们计算了接受SOC治疗的患者比例，并构建多变量模型以识别与接受SOC治疗相关的因素。
共纳入447名男性。其中，22.1%（99/447）接受了SOC治疗，而18.8%（84/447）根本未接受任何治疗。只有23.3%（104/447）进行了ILND，而80.9%（362/447）接受了全阴茎或部分阴茎切除术。种族和社会经济地位（SES）与SOC降低无关。调整分析显示，年龄增加（OR 0.93，95%CI：0.89 - 0.96）、Charlson合并症指数评分≥2（OR 0.53，95%CI：0.29 - 0.97）以及T3 - T4期疾病（OR 0.34，95%CI：0.18 - 0.65）与未接受SOC治疗相关。
65岁及以上患有浸润性阴茎癌的参保男性中，SOC治疗率较低，无论种族或SES如何。这一发现主要是由ILND率低所致。需要采取策略来克服浸润性阴茎癌男性接受SOC治疗的障碍。
