Glansectomy as Primary Management of Penile Squamous Cell Carcinoma: An International Study Collaboration

Tang, Dominic H.; Yan, Sylvia; Ottenhof, Sarah R.; Draeger, Desiree Louise; Baumgarten, Adam S.; Chipollini, Juan; Protzel, Chris; Zhu, Yao; Ye, Ding Wei; Hakenberg, Oliver W.; Watkin, N.; Spiess, Philippe E.

doi:10.1016/j.urology.2017.08.004

Cited by 16 publications

(15 citation statements)

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“…Smith et al [12] report a 4% LR rate in 72 patients treated with glansectomy for pT1 and pT2 pSCC, which is quite low. Conversely, more recent studies incline towards higher-risk tumours and show higher rates of LR [13,14]. A large series by Tang et al [14] showed a 7.6% LR rate in 410 patients who underwent glansectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, more recent studies incline towards higher-risk tumours and show higher rates of LR [13,14]. A large series by Tang et al [14] showed a 7.6% LR rate in 410 patients who underwent glansectomy. We have earlier reported on 117 patients undergoing glansectomy followed by splitthickness skin graft with an LR rate of 12.8%, which is consistent with the LR rate in the present multicentre cohort (10.5%) [13].…”

Section: Discussionmentioning

confidence: 99%

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Predictors of local recurrence and its impact on survival after glansectomy for penile cancer: time to challenge the dogma?

et al. 2020

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To identify predictive pathological factors for local recurrence (LR) and to study the impact of LR on survival in patients treated with glansectomy for penile squamous cell carcinoma (pSCC). Patients and MethodsWe retrospectively studied patients treated with glansectomy at international, high-volume reference centres. We analysed histopathological predictors of LR, stratified patients into risk groups based on the number of risk factors present, and studied the impact of LR on survival outcomes using Kaplan-Meier survival analysis and stepwise Cox proportional hazards regression models. Subsequently, we performed sensitivity analyses excluding margin-positive cases, pT3 disease, and cN+ disease, or all of these factors. ResultsAcross nine institutions, 897 patients were included, of whom 94 experienced LR. On multivariable analysis, presence of high-grade disease and pT3 stage were independent predictors of LR. LR-free survival rates significantly differed according to the number of risk factors present, with a hazard ratio (HR) of 1.90 (95% confidence interval [CI] 1.17-3.07; P = 0.01) for the intermediate-risk group (one risk factor) and 6.11 (95% CI 3.47-10.77; P < 0.001) for the high-risk group (two risk factors), using the low-risk group (no risk factors) as reference. Patients who experienced LR had significantly worse overall survival (OS; HR 2.89, 95% CI 2.02-4.14; P < 0.001) and cancer-specific survival (CSS; HR 5.64, 95% CI 3.45-9.22; P < 0.001). LR (HR 3.82, 95% CI 2.14-6.8; P < 0.001), lymphovascular invasion and cN status were significant predictors of decreased CSS. LR remained a strong predictor of both OS and CSS in all sensitivity analyses. ConclusionsPathological T3 stage and presence of high-grade disease were independent histopathological predictors of LR after glansectomy for primary pSCC, which allowed risk stratification into three groups with significantly different risk of developing LR. Additionally, LR is related to poor OS and CSS, indicating that LR is a manifestation of underlying aggressive disease and clearly challenging the dogma of using organ-sparing surgery whenever possible since survival is unaffected by higher LR rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of local recurrence and its impact on survival after glansectomy for penile cancer: time to challenge the dogma?

et al. 2020

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“…Immunohistochemical detection of p16 is used as a surrogate parameter for HPV association (2). The most commonly identified HPV serotypes are HPV 16,18,31,33,45,56, and 65. HPV-associated penile cancer can be distinguished from non-HPV-associated types by means of polymerase chain reaction (PCR) or immunohistochemistry.…”

Section: Pathology and Pathogenesis Of Penile Cancermentioning

confidence: 99%

“…The success of focal treatment should be confirmed by a follow-up biopsy. In most cases, local recurrences occur within 1 to 2 years after the initial treatment, most frequently after laser ablation (10-48%), less frequently after glans resurfacing (0-6%) and very rarely after glansectomy (0-2%) (16)(17)(18).…”

Section: Stage-adapted Treatmentmentioning

confidence: 99%

“…Inguinal lymph node dissection is associated with considerable morbidity in the form of lymphedema, lymphoceles and complications of wound healing. In older series, this morbidity reached levels of up to 50%, but advances in surgical technique have led to a reduction to a rate of approximately 25% (Figure 2) (17,18). Minimally invasive surgical techniques for inguinal lymph node dissection (laparoscopic, robotassisted) are associated with lower morbidity (19).…”

Section: Enlarged Inguinal Lymph Nodesmentioning

confidence: 99%

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The Diagnosis and Treatment of Penile Cancer

Hakenberg¹,

Dräger²,

Erbersdobler³

et al. 2018

Deutsches Ärzteblatt International

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enile cancer is an aggressive squamous cell carcinoma of the skin of the glans or of the inner layer of the prepuce, characterized by invasive growth and early metastatic spread to lymph nodes. While penile cancer is uncommon in Europe, incidence rates are very high in parts of South America and Africa. Since its treatment is often associated with significant cosmetic and functional defects, the disease is of critical importance to the affected men. Early metastatic spread to regional lymph nodes can be life-threatening. It is not uncommon that factors, both from the patient and the treating physician, are causing delays in diagnosis and start of treatment. With penile cancer being a comparatively rare disease, many physicians are unfamiliar with its management. Thus, several countries have centralized the treatment of this rare tumor. Penile cancer is an orphan disease. Due the low numbers of patients, no prospective randomized studies have become available. Most of the available data is from small retrospective studies; larger studies result from retrospective multicenter data collections. Thus, the level Summary Background: The incidence of penile cancer in Europe lies in the range of 0.9 to 2.1 cases per 100 000 persons per year. Carcinogenesis is associated with human papilloma virus (HPV) infection and with chronic inflammation. Methods: This review is based on publications (2010-2017) retrieved by a selective search in PubMed and EMBASE and on the guidelines of the European Association of Urology, the European Society of Medical Oncology, the National Comprehensive Cancer Network, and the National Institute for Health and Care Excellence (NICE). Results: 95% of cases of penile cancer are accounted for by squamous cell carcinoma, whose numerous subtypes have different clinical courses. Chronic preputial inflammation due to phimosis or lichen sclerosus is often associated with penile cancer. Circumcision lowers the risk of penile cancer (hazard ratio: 0.33). Maximally organ-preserving surgery with safety margins of no more than a few millimeters is the current therapeutic standard, because a local recurrence, if it arises, can still be treated locally with curative intent. Local radiotherapy can be performed in early stages. Lymphogenic metastasis must be treated with radical lymphadenectomy and adjuvant chemotherapy. Patients with clinically unremarkable inguinal lymph nodes nonetheless need invasive lymph node staging because of the high rate of lymphogenic micrometastasis. Conclusion: Penile cancer is curable in all early stages with the appropriate treatment, but its prognosis depends crucially on the proper management of the regional (i.e., inguinal) lymph nodes. In many countries, the treatment of this rare disease entity has been centralized.

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