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Penile cancer: A single center 15-year experience
8th European Multidisciplinary Meeting on Urological Cancers, 24-27 November 2016, Milan, Italy
P158
Penile cancer: A single center 15-year experience Eur Urol Suppl 2016; 15(13);e1758
Gil-Sousa D.1, Coutinho F.2, Oliveira-Reis D.1, Soares J.2, Louro N.2, Carvalho L.1, Fraga A.1 1
Centro Hospitalar do Porto, Dept. of Urology, Porto, Portugal, 2Centro Hospitalar do Porto, Dept. of Oncology, Porto, Portugal INTRODUCTION & OBJECTIVES: Penile cancer (NP) is a rare neoplasm, accounting for <1% of the tumors in man. The reduced incidence of this condition results in a limited number of randomized trials and low evidence for the best therapeutic approach. We describe a 15-year single center experience in the management of patients with PC. MATERIAL & METHODS: Retrospective analysis of 55 patients with PC, between 2000 and 2014. The association between categorical variables was evaluated by chi-square test or Fisher's exact test. The survival analysis was performed using the Kaplan-Meier method and log-rank test to compare groups. RESULTS: 55 patients with a mean age of 61.1 ±12.2 years [34.0 to 84.0]. 80.9% of the patients presented risk factors for PC (previous STDs 44.7%, phimosis 37,8% and balanitis 28.9%). Most patients presented a single (86.7%), vegetating lesion (56.3%) with an average duration of 12.9 ±15,9 months [2-60] and an average diameter of 31.7 ± 20,9mm [10.0 to 100.0]. 37,5% of the lesions were located in the glans (37.5%), followed by the sulcus (25%) and penile shaft (20.8%). Palpable lymph nodes were reported in 43.2% of patients, predominantly bilateral (50.0%) and mobile (62.5%). Squamous cell carcinoma was diagnosed in 98.0% of the cases, mostly well and moderately differentiated (45.2 and 40.5%, respectively), with lymphovascular invasion in 14.6%. The main surgical intervention was partial penectomy (69,1%), followed by wide excision of the lesion (16.4%) and glansectomy (5.5%). 8.6% of patients had previously undergone topical treatment. In terms of pathological staging, 10.7% had noninvasive disease (CIS / pTa), 27.6% pT1, 31.9% pT2, 27,7% pT3 and 2.1% pT4. Negative lymph node staging (cN0 and pN0) in 74.4% of the patients, N2 in 17.0% and N3 in 8.5%. Radical inguinal lymphadenectomy was performed in 30.6% of patients, with a mean number of nodes removed of 15.3 ±5.6 [1-25]. Pelvic lymphadenectomy was performed in 12.2% of the patients. 18.0% of patients had recurrence after surgical treatment, with a time interval between treatment-recurrence of 5.5 ± 3,9meses [1.0 to 12.0]. The correlation of several clinical and pathological variables with the risk of recurrence, lymph node involvement (N +) or metastatic disease (M +), showed a clinically significant association between greater diameter of the lesion and higher risk of recurrence (p = 0.027), and between palpable lymph nodes and greater risk of inguinal N+ (p = 0.004) and M+ (p = 0.026). Differential survival analysis, according to pT stage, lymph node involvement (N) or metastatic (M0/M +) confirmed lower survival rate of the most advanced stages. We register an overall mortality rate of 29.8%, for a mean follow-up of 41.2 months ± 32.8 [1.0 to 123.0]. CONCLUSIONS: The described cohort shows aggressive characteristics, with a high percentage of
Eur Urol Suppl 2016; 15(13);e1758
8th European Multidisciplinary Meeting on Urological Cancers, 24-27 November 2016, Milan, Italy
P158
Penile cancer: A single center 15-year experience Eur Urol Suppl 2016; 15(13);e1759
lesions in penile shaft (20.8%), ≥pT2 staging (61.7%), nodal involvement (25.5%) and metastatic disease (12.5%). This factor was reflected in a higher rate of radical surgical approaches and inguinal lymphadenectomy. In the series presented the diameter of the lesion was correlated with higher risk of recurrence and the presence of palpable lymph nodes with increased risk of N+ and M+. Survival curves reflect more aggressive disease at advanced stages.
Eur Urol Suppl 2016; 15(13);e1759 Powered by TCPDF (www.tcpdf.org)
P158
Penile cancer: A single center 15-year experience Eur Urol Suppl 2016; 15(13);e1758
Gil-Sousa D.1, Coutinho F.2, Oliveira-Reis D.1, Soares J.2, Louro N.2, Carvalho L.1, Fraga A.1 1
Centro Hospitalar do Porto, Dept. of Urology, Porto, Portugal, 2Centro Hospitalar do Porto, Dept. of Oncology, Porto, Portugal INTRODUCTION & OBJECTIVES: Penile cancer (NP) is a rare neoplasm, accounting for <1% of the tumors in man. The reduced incidence of this condition results in a limited number of randomized trials and low evidence for the best therapeutic approach. We describe a 15-year single center experience in the management of patients with PC. MATERIAL & METHODS: Retrospective analysis of 55 patients with PC, between 2000 and 2014. The association between categorical variables was evaluated by chi-square test or Fisher's exact test. The survival analysis was performed using the Kaplan-Meier method and log-rank test to compare groups. RESULTS: 55 patients with a mean age of 61.1 ±12.2 years [34.0 to 84.0]. 80.9% of the patients presented risk factors for PC (previous STDs 44.7%, phimosis 37,8% and balanitis 28.9%). Most patients presented a single (86.7%), vegetating lesion (56.3%) with an average duration of 12.9 ±15,9 months [2-60] and an average diameter of 31.7 ± 20,9mm [10.0 to 100.0]. 37,5% of the lesions were located in the glans (37.5%), followed by the sulcus (25%) and penile shaft (20.8%). Palpable lymph nodes were reported in 43.2% of patients, predominantly bilateral (50.0%) and mobile (62.5%). Squamous cell carcinoma was diagnosed in 98.0% of the cases, mostly well and moderately differentiated (45.2 and 40.5%, respectively), with lymphovascular invasion in 14.6%. The main surgical intervention was partial penectomy (69,1%), followed by wide excision of the lesion (16.4%) and glansectomy (5.5%). 8.6% of patients had previously undergone topical treatment. In terms of pathological staging, 10.7% had noninvasive disease (CIS / pTa), 27.6% pT1, 31.9% pT2, 27,7% pT3 and 2.1% pT4. Negative lymph node staging (cN0 and pN0) in 74.4% of the patients, N2 in 17.0% and N3 in 8.5%. Radical inguinal lymphadenectomy was performed in 30.6% of patients, with a mean number of nodes removed of 15.3 ±5.6 [1-25]. Pelvic lymphadenectomy was performed in 12.2% of the patients. 18.0% of patients had recurrence after surgical treatment, with a time interval between treatment-recurrence of 5.5 ± 3,9meses [1.0 to 12.0]. The correlation of several clinical and pathological variables with the risk of recurrence, lymph node involvement (N +) or metastatic disease (M +), showed a clinically significant association between greater diameter of the lesion and higher risk of recurrence (p = 0.027), and between palpable lymph nodes and greater risk of inguinal N+ (p = 0.004) and M+ (p = 0.026). Differential survival analysis, according to pT stage, lymph node involvement (N) or metastatic (M0/M +) confirmed lower survival rate of the most advanced stages. We register an overall mortality rate of 29.8%, for a mean follow-up of 41.2 months ± 32.8 [1.0 to 123.0]. CONCLUSIONS: The described cohort shows aggressive characteristics, with a high percentage of
Eur Urol Suppl 2016; 15(13);e1758
8th European Multidisciplinary Meeting on Urological Cancers, 24-27 November 2016, Milan, Italy
P158
Penile cancer: A single center 15-year experience Eur Urol Suppl 2016; 15(13);e1759
lesions in penile shaft (20.8%), ≥pT2 staging (61.7%), nodal involvement (25.5%) and metastatic disease (12.5%). This factor was reflected in a higher rate of radical surgical approaches and inguinal lymphadenectomy. In the series presented the diameter of the lesion was correlated with higher risk of recurrence and the presence of palpable lymph nodes with increased risk of N+ and M+. Survival curves reflect more aggressive disease at advanced stages.
Eur Urol Suppl 2016; 15(13);e1759 Powered by TCPDF (www.tcpdf.org)