Inguinal lymphadenectomy (I-LND) remains underutilized in patients with invasive penile cancer. Using a large national cancer registry, we assessed temporal trends in I-LND utilization and evaluated the impact of I-LND on the survival in patients in whom I-LND is an absolute indication per NCCN guidelines (T1b-4 N0/x-1).
The National Cancer Database (NCDB) was queried for all non-metastatic penile patients with T1b-4 N0/X-N1 squamous cell carcinoma of the penis from 2004-2014. Adjusting for patient, demographic, and clinicopathologic characteristics, multivariable logistic regression models were used to examine the association between available covariates and receipt of I-LND. Cox-proportional hazards regression analyses were then used to assess the impact of clinical and pathological variables on overall survival. A propensity score weighted analysis was performed to assess the effect of I-LND in overall survival.
A total of 2224 patients met criteria for analysis, of which 606 (27.2%) underwent I-LND. Following adjustment, I-LND utilization was more likely in younger patients, those presenting with palpable adenopathy (cN1), treated in an academic facility, and those with a more contemporary diagnosis. On survival analysis, controlling for all known and measured confounders, I-LND receipt was associated with improved OS (HR 0.79 [CI 0.74-0.84], p < 0.001).
In hospitals reporting to NCDB, the overall rate of I-LND for patients with invasive penile cancer was only 27.2%. Receipt if I-LND was associated with an increase in OS, justifying the use I-LND utilization as an important quality metric for performance reporting in patients with invasive penile cancer.
The Journal of urology. 2017 Dec 14 [Epub ahead of print]
Andres F Correa, Elizabeth Handorf, Shreyas S Joshi, Daniel M Geynisman, Alexander Kutikov, David Y Chen, Robert G Uzzo, Rosalia Viterbo, Richard E Greenberg, Marc C Smaldone
Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA; Department of Urology Creighton University, Omaha NE. Electronic address: ., Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia PA., Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA., Department of Hematology and Oncology, Division Genitourinary Oncology, Fox Chase Cancer Center, Philadelphia PA.