Racial differences in survival outcomes for early-stage (T1 tumor) penile cancer: Analysis from the Surveillance, Epidemiology, and End Results (SEER) database.

Abstract

5 Background: Penile cancer is a rare malignancy that accounts for less than 1% of male cancers in the United States. Localized disease, particularly T1 tumors (no invasion the corpora spongiosum, corpora cavernosa or adjacent structures using the AJCC 7th edition staging system) are potentially curable with local surgery. We present the racial differences in survival outcomes for T1, penile cancer from the SEER database. Methods: From 2004 to 2016, we identified all patients with T1 (coded as T1, T1a, T1b),N0,M0 penile cancer in the SEER-18 database were included. Univariate Kaplan-Meier analysis and multivariable (adjusting for age, year of diagnosis, race, socioeconomic status, primary tumor site and type of surgery) Cox-Regression analysis were conducted to investigate prognostic variables for cancer specific survival (CCS). Results: A total of 4,406 patients were identified with penile cancer; 1,941 patients had T1 disease and were further evaluated (Table). On multivariable analysis, Black (HR: 1.72, CI 1.01- 2.94; p=0.046) and Hispanic individuals (HR: 2.15, CI 1.36- 3.40; p= 0.001) had worse CSS compared to the White men with T1 disease. Logistic regression analysis shows no difference in the application of primary surgical resection by race (p=0.065). In the univariate analysis, patients who underwent primary site surgery had better 5-year CSS (HR: 0.36, CI 0.22-0.60; p <0.001). Among those undergoing primary surgery, the 5-year CSS was superior with excisional biopsy (HR: 0.22, CI 0.12-0.40; p < 0.001) compared to simple/partial removal of the primary tumor. Conclusions: Significant racial disparities in CSS exist in early-stage penile cancer patients. CSS is worse in Black and Hispanic T1 penile cancer patients compared to White patients. CSS is also decreased in those without any primary surgery and in those treated with simple/partial surgical removal compared to excisional biopsy. Further research on the cause of racial disparity outcomes in penile cancer is needed.[Table: see text]