Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival

Abstract

Purpose To report on the oncological outcome of organ-sparing surgery (OSS) compared to (total or partial) penectomy regarding recurrence patterns and survival in squamous cell carcinoma (SCC) of the penis. Methods This was a retrospective study of all patients with penile SCC and eligible follow-up data of at least 2 years at our institution. Patients with tumors staged ≥ pT1G2 underwent invasive lymph node (LN) staging by dynamic sentinel-node biopsy or modified inguinal lymphadenectomy. Radical inguinal lymphadenectomy was performed when LNs were palpable at diagnosis and in those with a positive LN status after invasive nodal staging. Follow-up visits were assessed, and local, regional and distant recurrences were defined and analyzed. Results 55 patients were identified with a mean follow-up of 63.7 months. Surgical management was OSS in 26 patients (47.2%) and partial or total penectomy in 29 cases (52.8%). Histopathological staging was: pTis (12.7%), pTa (16.3%), pT1a (18.2%), pT1b (5.5%), pT2 (29.1%) and pT3 (18.2%), respectively. Patients in the penectomy group were significantly older (mean 68 vs. 62 years; p = 0.026) with a higher rate of advanced tumor stage (≥ pT2: 44.8% vs. 11.5%; p = 0.002). The local recurrence rate was 42.3% (n = 11) following OSS compared to 10.3% (n = 3) after penectomy (p = 0.007). Kaplan-Meier curves showed no significant differences between the two groups regarding metastasis-free and overall survival. Conclusions OSS is associated with a higher local recurrence rate compared to penectomy, yet it has no negative impact on overall and metastasis-free survival.

Penile cancer: a Brazilian consensus statement for low- and middle-income countries

“…However, they have a higher risk of local recurrence, and physicians must closely monitor these patients through follow-up, especially when presenting perineural invasion, Tis, positive definitive margins, and high-grade tumors (Albersen et al 2018 ). Besides, organ-sparing surgery does not provide a significant difference in overall survival compared with total or partial penectomy (Lindner et al 2019 ; Djajadiningrat et al 2014a , b ). In the case of local recurrence after conservative treatment, the best option is partial amputation (consensus, LE: 2b), which provides a high local-control rate (94%) (Lont et al 2006 ), a low recurrence rate (approximately 5%), and the ability to maintain organ function (Leijte et al 2008 ).…”

Assessment of PI3K/mTOR/AKT Pathway Elements to Serve as Biomarkers and Therapeutic Targets in Penile Cancer

“…Interestingly, unlike OS, DSS and MFS (trend), the expression of AKT was not associated with RFS in the present study. This may be attributable to the fact that the given time-to-event variable RFS includes local recurrences besides regional and distant metastases, whereas local recurrence has presumably no negative impact on overall and metastasis-free survival in PeCa [ 29 ]. Notably, the direction of the association between AKT or pAKT expression and prognosis appears to vary depending on the malignancy.…”

What Is the Most Effective Management of the Primary Tumor in Men with Invasive Penile Cancer: A Systematic Review of the Available Treatment Options and Their Outcomes

“…Overall 3283 abstracts were screened and 235 studies were retrieved for full-text screening. Eighty-eight studies including 9758 patients were eligible for assessment: 16 NRCSs (1911 patients) [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] and 72 CSs (7864 patients) [6] , [7] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , …”