To identify predictive pathological factors for local recurrence (LR) and study its impact on survival in patients treated with glansectomy for penile squamous cell carcinoma (pSCC).
We retrospectively studied patients treated with glansectomy at international, high-volume reference centers. We analyzed histopathological predictors of LR, stratified patients in risk groups based on the number of risk factors present and studied the impact of LR on survival outcomes using Kaplan-Meier survival analysis and stepwise Cox proportional hazards regression models. Subsequently, we performed sensitivity analyses excluding margin-positive cases, pT3 disease and cN+ disease or all of these factors.
Across 9 institutions, 897 patients were included of which 94 experienced LR. On multivariable analysis, presence of high-grade disease and pT3 stage were independent predictors of LR. LR-free survival rates significantly differed according to the number of risk factors present with a HR of 1.90 (95%CI 1.17-3.07, p=0.01) for the intermediate-risk (1 risk factor) and 6.11 (95%CI 3.47-10.77, p<0.001) for the high-risk group (2 risk factors), using the low-risk group (no risk factors) as reference. Patients who experienced LR had significantly worse OS (HR 2.89, 95%CI 2.02-4.14, p<0.001) and CSS (HR 5.64, 95%CI 3.45-9.22, p<0.001). LR (HR 3.82, 95%CI 2.14-6.8, p<0.001), lymphovascular invasion and cN-status were significant predictors of decreased CSS. LR remained a strong predictor of both OS and CSS in all sensitivity analyses.
Pathological T3 stage and presence of high-grade disease are independent histopathological predictors of LR after glansectomy for primary pSCC, which allows for risk stratification in three risk groups with significantly different risk of developing LR. Additionally, LR is related to poor OS and CSS, indicating that LR is a manifestation of underlying aggressive disease and clearly challenging the dogma of using OSS whenever possible since survival is unaffected by higher LR rates.
BJU international. 2020 Nov 12 [Epub ahead of print]
Eduard Roussel, Eline Peeters, Joren Vanthoor, Giorgio Bozzini, Asif Muneer, Ben Ayres, Denosshan Sri, Nick Watkin, Rohit Bhattar, Arie Parnham, Vijay Sangar, Maurice Lau, Gregory Joice, Trinity J Bivalacqua, Juan Chipollini, Philippe E Spiess, Georgios Hatzichristodoulou, Lieke de Vries, Oscar Brouwer, Maarten Albersen, eUROGEN, the young academic urologists (YAU) working group of men’s health
Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Urology, ASST Valle Olona, Busto A. Varese, Lombardia, Italy., Department of Urology and NIHR Biomedical Research Centre, University College London Hospital, London, United Kingdom., Department of Urology, St.-George's University Hospitals, NHS Foundation Trust, London, United Kingdom., Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom., Department of Urology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States., Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, United States., Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany., Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.