Abstract
ObjectivePenile cancer is a rare malignancy, with a reported incidence of 1.5/100,000 males in the Republic of Ireland in 2015. The aim of this study was to perform the first national review and to evaluate clinicopathological factors affecting survival. Subjects and methodsAll cases of penile cancer in Ireland between 1995 and 2010 were identified through the National Cancer Registry Ireland (NCRI) and analysed to identify factors affecting survival. Results360 cases of penile cancer were identified, with a mean age at diagnosis of 65.5 years and 88% (n = 315) of cases occurred in those over 50. 91% (n = 328) of cases were squamous cell carcinomas (SCC). The majority of patients were treated surgically (n = 289), with 57% (n = 206) and 24% (n = 87) undergoing partial penectomy and total penectomy respectively. Only 18% (n = 65) received radiotherapy, and 8% (n = 27) received chemotherapy. Mean overall survival (OS) was 113 months, and five year disease specific survival (DSS) was 70% (95%CI: 59.1–77.8%). Age at diagnosis, nodal status and presence of metastatic disease were independent prognostic markers on multivariate analysis. ConclusionThis study represents the first national review of penile cancer in Ireland. The annual incidence and survival rates are comparable to European figures, though superior DSS has previously been reported from our institution, highlighting the role for centralisation of care in Ireland. Level of evidence2b.
Highlights
Penile cancer is a rare malignancy, with an average incidence of around 1 per 100,000 in Europe, though significantly higher rates are seen in the developing world.[1]
Well documented risk factors include a history of phimosis, chronic inflammation, smoking, poor hygiene, and Human papilloma virus (HPV) infection; in particular HPV types 16 and 18.3 The presence of HPV is associated with Squamous cell carcinoma (SCC) of the penis in 50% of cases, which may explain the higher incidence of penile cancer in countries where HPV is more prevalent such as Brazil and Uganda.[4]
There is a paucity of large, prospective randomised studies in the literature due to the rare nature of the disease, and as such, defining optimal management of penile cancer remains challenging
Summary
Penile cancer is a rare malignancy, with an average incidence of around 1 per 100,000 in Europe, though significantly higher rates are seen in the developing world.[1]. While early lymphadenectomy in such patients offers a significant survival benefit, it carries a high risk of morbidity.[6] There is a paucity of large, prospective randomised studies in the literature due to the rare nature of the disease, and as such, defining optimal management of penile cancer remains challenging. To address these challenges, there has been a recent move towards centralisation of treatment in many countries with improved patient outcomes demonstrated.[7] While discussions regarding the centralisation of penile cancer services in Ireland have begun, it has yet to be implemented, despite a growing body of Please cite this article as: Anderson S et al, Penile cancer in Ireland e A national review, The Surgeon, https://doi.org/10.1016/ j.surge.2021.04.004 the surgeon xxx (xxxx) xxx evidence to support it.[8,9] The aim of this study was to perform the first review of national data on penile cancer in Ireland
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