BETHESDA, MD USA (UroToday.com) - Background: Per the NCCN guidelines, inguinal lymph node dissection (ILND) is recommended for patients with intermediate (T1b) or high (Any T2 or Grade 3) risk disease even in the absence of palpable inguinal nodes. Our objective was to assess temporal trends in utilization of ILND and to determine factors associated with the receipt of ILND using National Cancer Database (NCDB).
Methods: The NCDB was queried for all patients diagnosed with T2 penile cancer from 1998-2011. Temporal trends for receipt of ILND were assessed. Adjusting for patient, demographic, and clinicopathologic characteristics, multivariable logistic regression models were used to examine the association between available covariates and receipt of ILND.
Results: Of 2019 patients identified over the study period, 693 (34.3%) underwent ILND. Rates of ILND did not significantly improve from 1998 to 2011 (34.2 to 40.0%; p = 0.09). Significant differences were observed in patients undergoing ILND with respect to age (p < 0.001), Hispanic ethnicity (p=0.04), insurance status (p < 0.001), and facility type (p < 0.001), while no changes were seen with respect to race, income, education, urban/rural location, tumor grade, or Charlson co-morbidity score. Following adjustment, patients with high grade disease (OR 1.35 [CI 1.1-1.7]) and those treated at academic centers (OR 3.2 [CI 2.2-4.7]) were more likely to receive ILND, while patients > 70 years of age (OR 0.41 [CI 0.28-0.60]) were less likely to receive ILND.
Conclusions: In the NCDB, less then 35% of patients with T2 penile cancer receive ILND and the rates have not significantly changed over the last decade. Referral of patients with this uncommon, highly morbid lethal disease to experienced centers may increase adherence to guideline recommended care.
Presented by:
Mohammed Haseebuddin, Elizabeth Handorf, Nikhil Wainganker, Rosalia Viterbo, Richard Greenberg, Robert Uzzo, Alexander Kutikov, Marc Smaldone, and David Chen
Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA USA
Presented at the 2014 Winter Meeting of the Society of Urologic Oncology (SUO) "Defining Excellence in Urologic Oncology" - December 3 - 5, 2014 - Bethesda, MD USA