An update on penile cancer: Evaluating management trends and clinical outcomes using the National Cancer Data Base.

Abstract

492 Background: Penile cancer remains a rare disease in the United States and may be associated with substantial morbidity and even mortality. Though the understanding of penile cancer is limited by the uncommon nature of the disease, the use of large volume datasets may help reveal recent management trends and clinical factors associated with treatment. We sought to describe penis cancer management over the past several years using the National Cancer Data Base. Methods: We performed a retrospective review of data obtained from the National Cancer Data Base from 1998-2012. We analyzed patient characteristics, demographic information, and therapeutic approaches within two clinical scenarios: 1) use of partial penectomy for early stage (clinical Ta-T2 disease); and 2) use of chemotherapy for metastatic disease. We performed multivariate logistic analysis to determine factors associated with these treatments. Results: A total of 2,677 patients presented with cTa-T2 penile carcinoma. Of these, the proportion receiving partial penectomy increased from 73.9% in 1998-2000, to 80.4% in 2010-2012 (p < 0.001). Compared to those aged 50-59, partial penectomy was more common in the old (age > 80, OR 1.52, 95% CI 1.05 – 2.20) and young (age < 50, OR 1.47, 95% CI 1.04 – 2.07). Treatment at academic centers and those without insurance were less likely to receive partial penectomy (both p < 0.01), as were patients with cT2 and node positive disease (both p < 0.001). Of those presenting with metastatic disease (n = 817), use of chemotherapy increased over the time period from 39% receiving chemotherapy in 1998-2000, to 49% in 2010-2012 (p <0.03). Patients least likely to receive chemotherapy were older and with higher Charlson Comorbidity score (both p < 0.05), African American (OR 0.46, 95% CI 0.29 – 0.70), and those living > 50 miles from the nearest treatment hospital (OR 0.37, 95% CI 0.25 – 0.55). Conclusions: Penile sparing surgery and use of chemotherapy are becoming more commonly utilized over the last several years. Multiple factors appear to be associated with these trends, and further work is needed to define both clinical and non-clinical factors associated with treatment.