30-YEAR SINGLE-INSTITUTIONAL EXPERIENCE OF PARTIAL PENECTOMY IN THE TREATMENT OF PENILE CANCER

Andrea Guttilla1, Giovanni Lughezzani2, Mario Catanzaro3, Tullio Torelli3, Silvia Stagni3, Davide Biasoni3, Nicola Nicolai3, Luigi Piva3, Andrea Necchi3, Patrizia Giannatempo3, Daniele Raggi3, Roberto Salvioni3
  • 1 Clinica Urologica Università di Padova, Dipartimento di Scienze Chirurgiche, Oncologiche e Grastroenterologiche (Padova)
  • 2 Università Vita-Salute San Raffaele, Unità di Urologia (Milano)
  • 3 Fondazione IRCSS Istituto Nazionale dei Tumori, Unità di Urologia (Milano)

Objective

INTRODUCTION
Partial penectomy (PP) is an option in selected patients with locally-invasive penile cancer (PC). Few studies investigated long-term oncological outcomes.

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Methods and results

METHODS
Data from 210 patients treated with PP for PC between January 1980 and June 2012 were retrieved from our institutional database. Patients were staged according to the 2002 TNM classification. Patients without clinical evidence of enlarged lymph nodes where staged as pNx. Kaplan-Meier curves were used to determine cancer-specific survival (CSS) rates. Univariable and multivariable Cox regression models tested the predictors of CSS.
RESULTS
Mean patient age was 59.2 years old (range 21-92). Overall, 68 (32.4%), 114 (54.3%) and 28 (13.3%) had respectively pT1, pT2 and pT3 disease. Nodal stage was pN0/x in 102 (48.6%), pN1 in 43 (20.5%), pN2 in 41 (19.5%) and pN3 in 24 (11.4%) patients. Pathological grade was well, moderately and poorly differentiated in respectively 76 (36.2%), 91 (43.3%) and 43 (20.5%) patients. PSM were detected in 13 (6.1%) patients. All of these patients were subsequently subjected to total penectomy. Mean follow-up was 58 months (range 2-280). Overall, 5-year CSS was 77.9%. When stratified according to pathological stage, 5-year CSS rates were 85.1%, 76.1% and 65.4% in pT1, pT2 and pT3 patients (p=0.003), and 90.5%, 78.1%, 73.7% and 33.5% in pN0/x, pN1, pN2 and pN3 patients (p<0.001). Similarly, 5-year CSS rates were 87.0%, 75.1% and 59.9% in patients with well, moderately and poorly differentiated disease (p=0.008), respectively. At multivariable Cox regression analyses, pN stage was the only independent predictor of CSS (p<0.001). Specifically, patients with pN3 disease had a 10.6-fold higher probability of dying of their disease relative to individuals with pN0/x disease (95% CI: 4.0-27.9).

Discussion

CONCLUSIONS
PP represents an oncologically safe treatment option in patients with locally-invasive PC. Even in patients treated with PP, N is the most powerful predictor of CSS.

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