Oncological therapy to Swedish men with metastatic penile cancer 2000–2015

Abstract

Background: Penile cancer is an uncommon disease with poor prognosis when spread to more than one inguinal lymph node. Recommendations on chemo-and radiotherapy in treatment guidelines are based on low-grade evidence. There are to our knowledge no described population-based cohort with detailed information on given oncological treatment and survival data. The aim of this study is to investigate in detail how men with metastatic penile cancer have been treated with chemotherapy and radiotherapy over time, and how survival varies with N-stage and given treatment. Material and methods: For this observational cohort study all men in Sweden diagnosed with penile cancer with lymph node-or distant metastases 2000-2015 were identified through the Swedish National Penile Cancer Register (NPECR). Medical records were retrieved and 325 men were confirmed to have metastatic penile cancer (T any , c or pN1-3 and/or M1). Information on treatments was collected. Causes of death were retrieved from the National Cause of Death Register (CDR). Results: Chemotherapy and/or radiotherapy were given to 172 (53%) of all men. The use of oncological treatments with curative intent increased significantly during the study period, from 30% of men with c/pN2-3 diagnosed 2000-2003 compared with 57% of men diagnosed 2012-2015. Ninetythree (29%) men received oncological treatments with curative intent of whom 85/93 (91%) had stage c/pN2-3M0. Survival decreased with higher N-stage, M1-stage, and absence of oncological treatment with curative intent. For men with c/pN3-stage, the engagement of pelvic lymph nodes was entailed with lower survival than pN3 based on extra-nodal extension (ENE). Conclusion: The use of oncological treatment was below recommendations in guidelines but increased during the study period. Treatment was given predominantly to men with c/pN2-3 and M1disease. Survival was higher among men treated with curative intent; this could be due to patient selection bias.

Long-Term Periodic and Conditional Survival Trends in Prostate, Testicular, and Penile Cancers in the Nordic Countries, Marking Timing of Improvements

“…Penile cancer is a rare cancer, and the treatment recommendations in a metastatic state may not be evidence-based [38]. The relatively poor 1-year survival suggests that diagnosis is derived late in the disease causation.…”

“…The relatively poor 1-year survival suggests that diagnosis is derived late in the disease causation. It is known that the prognosis is worsened if more than one inguinal lymph node is affected [38]. Reasons for delayed diagnosis may be prudishness and embarrassment for seeking medical opinion, lack of urological resources, or simply poor knowledge of this rare but easily visible cancer [39].…”

Systemtherapie des Peniskarzinoms – neue Konzepte? Neue Erfolge?

“…In Fällen mit begrenzter Lymphknotenmetastasierung ist mit multimodaler Therapie eine Heilung möglich. Neoadjuvante und adjuvante Chemotherapie wird dazu von den Leitlinien empfohlen und wird in den letzten Jahren vermehrt angewandt [34].…”