Jannello Letizia Maria Ippolita, de Angelis Mario, Siech Carolin, Di Bello Francesco, Rodriguez Peñaranda Natali, Tian Zhe, Goyal Jordan A, Luzzago Stefano, Mistretta Francesco A, Boeri Luca, Saad Fred, Chun Felix K H, Briganti Alberto, Puliatti Stefano, Longo Nicola, de Cobelli Ottavio, Musi Gennaro, Karakiewicz Pierre I
Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada.
Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.
Ann Surg Oncol. 2025 Aug;32(8):6151-6157. doi: 10.1245/s10434-025-17352-3. Epub 2025 Apr 22.
Local tumor destruction (LTD) represents a relatively novel approach for the management of early-stage squamous cell carcinoma of the penis (SCCP). Its cancer control efficacy has never been tested in large-scale epidemiologic studies. We addressed this knowledge gap and tested for differences in cancer-specific mortality (CSM) between LTD versus partial penectomy (PP) in T1aN0M0 SCCP.
Within the Surveillance, Epidemiology, and End Results database (2000-2020), we identified T1aN0M0 SCCP patients treated with LTD or PP. Cumulative incidence plots as well as multivariable competing risks regression models addressed CSM. Additional accounting was made for the confounding effect of other-cause mortality.
Of 1,239 patients with T1aN0M0 SCCP, 615 (49.6%) underwent LTD versus 624 (50.4%) PP. The majority of patients were Caucasian in LTD 393 (63.9%) and in PP 406 (65.1%) groups. Local tumor destruction patients were young (median age 65 versus 70 years). In cumulative incidence plots, 10-year CSM was 12.4% in LTD versus 13.5% in PP SCCP patients (p = 0.8). In multivariable competing risks regression models, LTD did not independently predict higher CSM relative to PP (hazard ratio 0.99; p = 0.97).
In this large population-based cohort of T1a SCCP patients, the rate of LTD virtually perfectly approximated that of PP. Local tumor destruction patients exhibited virtually the same cancer-control outcomes as their PP counterparts. In consequence, LTD may be considered a safe alternative to PP in T1aN0M0 SCCP based on cancer-control outcomes.
局部肿瘤破坏（LTD）是一种相对新颖的治疗早期阴茎鳞状细胞癌（SCCP）的方法。其癌症控制效果从未在大规模流行病学研究中得到检验。我们填补了这一知识空白，并测试了T1aN0M0期SCCP患者中LTD与部分阴茎切除术（PP）在癌症特异性死亡率（CSM）方面的差异。
在监测、流行病学和最终结果数据库（2000 - 2020年）中，我们确定了接受LTD或PP治疗的T1aN0M0期SCCP患者。累积发病率图以及多变量竞争风险回归模型用于分析CSM。还对其他原因导致的死亡率的混杂效应进行了额外考量。
在1239例T1aN0M0期SCCP患者中，615例（49.6%）接受了LTD，624例（50.4%）接受了PP。LTD组和PP组的大多数患者为白种人，分别为393例（63.9%）和406例（65.1%）。接受局部肿瘤破坏治疗的患者较年轻（中位年龄65岁对70岁）。在累积发病率图中，LTD组SCCP患者的10年CSM为12.4%，PP组为13.5%（p = 0.8）。在多变量竞争风险回归模型中，与PP相比，LTD并不能独立预测更高的CSM（风险比0.99；p = 0.97）。
在这个基于大人群的T1a期SCCP患者队列中，LTD的比例几乎与PP完全接近。接受局部肿瘤破坏治疗的患者与接受PP治疗的患者表现出几乎相同的癌症控制效果。因此，基于癌症控制效果，在T1aN0M0期SCCP中，LTD可被视为PP的一种安全替代方案。
