Penile cancer (PeCa) represents a diagnostic and therapeutic challenge given the low patient volume, which may result in inadequate physician expertise and poor guideline adherence. Since 2015, we have developed a specific care pathway for PeCa in our tertiary referral center.
To evaluate the impact of a dedicated PeCa care pathway on patient management, the adequacy of pathological reporting, and oncological outcomes.
We retrospectively queried our institutional registry (S-66482) to identify patients who were surgically treated for PeCa between January 1989 and April 2022. The patient numbers were evaluated within a broader national context.
We compared patient, surgery, tumor, and pathological data before and after 2015. Kaplan-Meier analysis was used to compare local and regional recurrence rates and cancer-specific survival (CSS).
Overall, 313 patients were included, of whom 204 (65.1%) were surgically treated after 2015. The median number of patients treated yearly was significantly higher after 2015 (26 vs 5; p < 0.01). Patients treated after 2015 more frequently had no palpable lymph nodes at diagnosis, despite similar primary tumor stage. After adoption of the PeCa care pathway, organ-sparing surgery (OSS) was more commonly performed (79.9% vs 57.8%; p < 0.01) despite local staging being similar and without observing a significant increase in positive margins. Surgical staging in patients with European Association of Urology intermediate- or high-risk tumors was conducted more frequently after 2015 (90% vs 41%; p < 0.01). Pathology reporting was standardized, and there was more frequent reporting of p16 staining status (81.4% vs 8.3%; p < 0.01), lymphovascular invasion (93.8% vs 44.3%; p < 0.01), and perineural invasion (92.4% vs 44.3%; p < 0.01) following implementation.
Implementation of a standardized care pathway for PeCa resulted in higher rates of OSS and pathological nodal staging and more complete pathology reports. Considering that these changes were associated with an increase in the number of patients treated, academic-driven centralization may play a role in optimizing the management of these patients.
We evaluated the impact of a care pathway for patients with penile cancer on patient management, the completeness of pathology reporting, and cancer control. We found that implementation of this pathway was associated with an increase in the number of patients treated, higher rates of organ-sparing surgery and lymph node staging, and more complete pathology reports. Centralization of care may play a role in optimizing the management of penile cancer.
European urology focus. 2023 Aug 01 [Epub ahead of print]
Alessio Pecoraro, Laura Elst, Eduard Roussel, Marija Miletić, Joren Vanthoor, Dirk De Ridder, Anne-Sophie Van Rompuy, Eline De Cuyper, Herlinde Dumez, Gert De Meerleer, Liesbeth de Wever, Karolien Goffin, Hendrik Van Poppel, Steven Joniau, Maarten Albersen
Department of Urology, University Hospitals Leuven, Leuven, Belgium; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Urology, University Hospitals Leuven, Leuven, Belgium; Clinical Department of Oncology and Nuclear Medicine, Sisters of Mercy University Hospital Center, Zagreb, Croatia., Department of Urology, University Hospitals Leuven, Leuven, Belgium; Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium; Department of Quality Improvement, University Hospitals Leuven, Leuven, Belgium., Department of Pathology, University Hospitals Leuven, Leuven, Belgium., Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium., Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium., Department of Radiology, University Hospitals Leuven, Leuven, Belgium., Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium., Department of Urology, University Hospitals Leuven, Leuven, Belgium. Electronic address: .