Prognostic Factors of Penile Cancer and the Efficacy of Adjuvant Treatment after Penectomy: Results from a Multi-institution Study

Abstract

BackgroundPenile cancer is a rare malignancy associated with high rates of mortality and morbidity. Currently, the efficacy of adjuvant treatment (AT), including radiotherapy and chemotherapy, for penile cancer remains unclear. Therefore, we investigated the prognostic factors for treatment outcomes and the efficacy of AT in consecutive patients who underwent penectomy for penile cancer at multiple Korean institutions between 1999 and 2013.MethodsAT was defined as the administration of chemotherapy, radiotherapy, or both within 12 months after initial treatment. All patients were divided into two groups according to the AT status.ResultsForty-three patients (median age 67.0 years) with a median follow-up after penectomy of 26.4 (interquartile range: 12.0–62.8) months were enrolled. Patients with AT had a significantly higher pathologic stage. However, no differences in age, histologic grade, or type of surgery were identified according to the presence of AT. The 3- and 5-year cancer-specific survival (CSS) rates were 79.0% and 33.0%, respectively. In a multivariate analysis, American Joint Committee on Cancer (AJCC) stage ≥ III disease was an independent predictor of CSS and recurrence-free survival (RFS). However, AT was not associated with CSS and RFS. The type of primary surgical treatment and inguinal lymph node dissection at diagnosis were also not significantly associated with overall survival, CSS, or RFS.ConclusionAJCC stage ≥ III disease, which mainly reflects lymph node positivity, is a significant prognosticator in patients with penile cancer. By contrast, AT does not seem to affect CSS and RFS.

Copy Number Analysis Reveal Genetic Risks of Penile Cancer

“…Overall survival and recurrence-free survival in our study were higher than in Jong Won’ s study ( 26 ), the possible reason for which was that the pathological stage of the patients in our study were all≤T2, while the pathological stage ≥T3 accounts for 30.2% in Jong Won’ s study resulting to the lower OS and RFS. The patients in our study had earlier stages of pathology, perhaps because modern people in our region are more concerned about their health.…”

“…Currently, significant poor prognosticator in patients with penile cancer include lymph node positivity ( 27 ), metastatic nodes≥ 4 ( 28 ), AJCC stage ≥ III disease ( 26 ), pathologic stage of the primary tumor ( 29 ), histologic grade<G1 ( 30 , 31 ), a tumor thickness≥ 5 mm ( 32 ), vertical growth pattern ( 33 ), age<53, Lactate Dehydrogenase (LDH)<188.5 U/L and Platelet-lymphocyte Ratio (PLR)<133.5 ( 34 ), p53 positivity ( 31 ), Human papillomavirus infection ( 35 ). However, there are few studies on the prognosis of penile cancer at the gene level, so our study also studied the gene types of prognostic factors later.…”

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

“…Patients not undergoing neoadjuvant treatment, but who have inguinal and pelvic lymphadenectomy and metastases in pelvic lymph nodes with bilateral inguinal lymph-node involvement or extranodal extension, should receive adjuvant treatment with chemotherapy and radiotherapy (recommendation, LE: 2b) with a cisplatin-based triple scheme (with taxane) (recommendation, LE: 2b), even if the evidence is still controversial. Adjuvant treatment improves overall survival (Sharma et al 2015 ), but also shows no difference compared with no treatment (Kim et al 2018 ; Choo et al 2019 ). …”

TERT Promoter Mutations in Penile Squamous Cell Carcinoma: High Frequency in Non-HPV-related Type and Association With Favorable Clinicopathologic Features

“…However, this has not been the case for penile cancer, as the underlying molecular pathogenesis has yet to be elucidated, which is most likely due to the rarity of penile SCC. Accordingly, no standardized treatment or personalized medicine has yet been established for penile cancer [8].…”