Adherence to the EAU guidelines on Penile Cancer Treatment: European, multicentre, retrospective study

Abstract

Purpose The European Association of Urology (EAU) guidelines for penile cancer (PC) are exclusively based on retrospective studies and have low grades of recommendation. The aim of this study was to assess the adherence to guidelines by investigating the management strategies for primary tumours and inguinal lymph nodes. Methods We retrospectively reviewed the clinical charts of 176 PC patients who underwent surgery in eight European centres from 2010 to 2016. The stage and grade were assessed according to the 2009 AJCC-UICC TNM classification system. To assess adherence rates, we compared theoretical and practical adherence to the EAU guidelines. Results Overall, 176 patients were enrolled. Partial amputation was the most frequent surgical approach (39%). 53.7% of tumours were stage Tis-T1b and the remaining 46.3% were stage T2-T4. Palpable lymph nodes were detected in 30.1% of patients and 45.1% underwent lymphadenectomy (LY). A sizeable group of tumours (43.2%) were N0. For primary treatment, adherence to the EAU guidelines was good (66%). In non-adherent cases, reasons for discrepancy were patient's choice (17%), surgeon's preference (36%), and other causes (47%). For LY, the guideline adherence was 70%, with either patient's or surgeon's choice or other causes accounting for discrepancy in 28, 20, and 52% of non-adherent cases, respectively. Conclusion Adherence to the EAU guidelines for PC was quite high across the eight European centres involved in the study. This notwithstanding, strategies for further improvement should be developed and evenly adopted.

Adherence to the EAU Guideline Recommendations for Local Tumor Treatment in Penile Cancer: Results of the European PROspective Penile Cancer Study Group Survey (E-PROPS)

“…In contrast, only 1.9% chose a too superficial procedure, laser therapy (0.6%) or resurfacing of the glans 1.3%. This is in line with the findings of Bada et al and Cindolo et al who also showed that physicians are more likely to choose a too radical rather than a too superficial surgical approach, a problem that is aggravated in less experienced centers [11,15]. On a positive note, [90% of the physicians that participated in our survey stated that penile-sparing surgery is common practice in their department.…”

“…In one-third of the patients who did not receive correct local tumor therapy, this was due to surgeons' preference. In the majority of cases, this led to a more aggressive therapeutic approach [8]. This observation coincides with data of the Swedish national PeCa register.…”

“…Consequently, the guidelines are of particular importance in the management of these patients. As we know from previous retrospective studies, the contrary position of the treating physician is one of the main reasons that treatment regimens do not follow the guidelines [8]. This in turn explains the strength of our study.…”

“…A recently published retrospective multicenter study demonstrated that only 66% of patients received local tumor therapy that complied with the recommendations of the 2009 EAU guidelines on PeCa [8]. In one-third of the patients who did not receive correct local tumor therapy, this was due to surgeons' preference.…”

Leitlinienadhärenz

“…Für die urologischen Erkrankungsbilder gibt es mittlerweile eine umfangreiche Sammlung solcher Leitlinien und v. a. in der Uroonkologie bereits einen großen Erfahrungsschatz mit einer entsprechenden Historie zum Umgang mit Leitlinien -sowohl bei der Erstellung als auch bei deren Nutzung und Verbreitung. Auch liefert die steigende Zahl an Untersuchungen zur Adhärenz der Leitlinien unbestritten Hinweise zu deren Nutzen [1][2][3] Hier steht eine Anzeige.…”