Adherence to guideline recommendations for lymph node dissection in squamous cell carcinoma of the penis: Effect on survival and complication rates.

We analyzed adherence rates to contemporary guidelines regarding inguinal lymph node dissection (ILND) for squamous cell carcinoma of the penis, as well as ILND association with cancer specific mortality (CSM), and complication rates.

Within the Surveillance, Epidemiology, and End Results and the National Inpatient Sample databases, 943 and 317 nonmetastatic penile cancer patients (1998-2015) were respectively identified. Multivariable analyses focused on ILND rates, CSM, and complication rates. Inverse probability of treatment weighting adjustment was used in CSM analyses.

Within the Surveillance, Epidemiology, and End Results database, ILND was performed in 233 (24.7%) patients. ILND rates did not vary over time (P = 0.2). In the overall cohort (n = 943), ILND was an independent predictor of lower CSM (hazards ratio [HR]: 0.42; P < 0.001). In Multivariable CSM analyses stratified according to N-stage, ILND was associated with lower CSM in N1 (HR: 0.25; P < 0.001) and N2-3 (HR: 0.42; P = 0.01), but not in N0 patients. Within the National Inpatient Sample database, presence of LN invasion (LNI) was associated with longer hospitalization (odds ratio: 1.27, P = 0.01), but not with higher complications or in-hospital mortality.

The adherence to guidelines for ILND was low (24.7%), and did not change over time. Nonetheless, a CSM benefit related to ILND was observed in N1, N2, and N3 patients. Complication rates and in-hospital mortality did not differ according to LNI. However, hospital stay may be longer in LNI patients. Finally, it should be noted that lack of distinction between clinical and pathological N-stage represents an important limitation.

Urologic oncology. 2019 Jul 08 [Epub ahead of print]

Francesco A Mistretta, Elio Mazzone, Carlotta Palumbo, Sophie Knipper, Zhe Tian, Sebastiano Nazzani, Derya Tilki, Gennaro Musi, Paul Perrotte, Emanuele Montanari, Shahrokh F Shariat, Fred Saad, Alberto Briganti, Ottavio de Cobelli, Pierre I Karakiewicz

Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Department of Urology, European Institute of Oncology, Milan, Italy. Electronic address: ., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Urology Unit, Department of Medical and Surgical Specialties, ASST Spedali Civili of Brescia, Radiological Science and Public Health, University of Brescia, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Martini-Klinik, Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy., Martini-Klinik, Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, European Institute of Oncology, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada., Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria., Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, European Institute of Oncology, Milan, Italy; Dipartimento di Emato-Oncologia ed Oncologia, University of Milan, Milan, Italy.

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