To evaluate racial disparities in the diagnosis and treatment of penile cancer among a contemporary series of men from a large diverse national data base.
Using the 1998-2012 National Cancer Data Base, all men with squamous cell carcinoma (SCC) were stratified by race and ethnicity. Demographic and disease characteristics were compared between groups. Likelihood of undergoing surgery and type of surgery were compared among patients with non-metastatic disease. Factors influencing disease stage and treatment type were analyzed with univariate and multivariable logistic regressions. Overall survival was examined with Kaplan Meier and adjusted Cox proportional hazard models.
We identified 12,090 men with penile SCC with median age 66 years (range 18-90). 76.8% of men are Caucasian, 10.2% AA, 8.7% Hispanic. On multivariable analysis, Hispanic men are more likely to present with high risk (≥T1G3) penile SCC (OR 1.6; CI 1.20 - 2.00; p=0.001) and tend to undergo penectomy rather than penile-sparing surgery (OR 1.46; CI 1.15-1.85; p=0.002) for equal stage SCC compared to Caucasian patients. Whereas, AA men are less likely to undergo surgery of any type (OR 0.67; CI 0.51-0.87; p=0.003) and have higher mortality rates than Caucasian patients (HR 1.25; CI 1.10-1.42; p<0.001).
Hispanic men with penile SCC are more likely to present with high-risk disease and undergo more aggressive treatment than Caucasian patients but have comparable survival. AA men are less likely to undergo surgical management of their disease and have higher mortality rates.
Urology. 2016 Jul 08 [Epub ahead of print]
Emily A Slopnick, Simon P Kim, Jonathan E Kiechle, Christopher M Gonzalez, Hui Zhu, Robert Abouassaly
Urology Institute, University Hospitals Case Medical Center, Cleveland, OH. Electronic address: ., Urology Institute, University Hospitals Case Medical Center, Cleveland, OH., Urology Institute, University Hospitals Case Medical Center, Cleveland, OH., Urology Institute, University Hospitals Case Medical Center, Cleveland, OH., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH., Urology Institute, University Hospitals Case Medical Center, Cleveland, OH.