Competing-risks analysis in patients with T1 squamous cell carcinoma of the penis

Authors

  • Rodolphe Thuret,

    Corresponding author
    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada
    2. Department of Urology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
    Search for more papers by this author
    • Both authors contributed equally to this work.

  • Maxine Sun,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada
    Search for more papers by this author
    • Both authors contributed equally to this work.

  • Firas Abdollah,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada
    2. Department of Urology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
    3. Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
    Search for more papers by this author
  • Lars Budaus,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada
    2. Department of Urology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
    3. Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
    4. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
    Search for more papers by this author
  • Shahrokh F. Shariat,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada
    2. Department of Urology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
    3. Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
    4. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
    5. Department of Urology, Weill Cornell Medical Center, New York, NY, USA
    Search for more papers by this author
  • François Iborra,

    1. Department of Urology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
    Search for more papers by this author
  • Jacques Guiter,

    1. Department of Urology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
    Search for more papers by this author
  • Jean-Jacques Patard,

    1. Department of Urology, Kremlin-Bicetre Hospital, France
    Search for more papers by this author
  • Pierre I. Karakiewicz

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada
    2. Department of Urology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
    3. Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
    4. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
    5. Department of Urology, Weill Cornell Medical Center, New York, NY, USA
    6. Department of Urology, Kremlin-Bicetre Hospital, France
    7. Department of Urology, University of Montreal, Montreal, Canada
    Search for more papers by this author

  • R.T. and M.S. contributed equally to this work.

Rodolphe Thuret, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), 1058 rue St-Denis, Montréal, QC, Canada H2X 3J4. e-mail: rodolphethuret@gmail.com

Abstract

What's known on the subject? and What does the study add?

The European Association of Urology (EAU) guidelines recommend an inguinal lymph node dissection (ILND) in patients with T1G2-3 squamous cell carcinoma of the penis (SCCP). To date, only four series reported the rates of cancer-specific mortality (CSM) after primary tumor excision (PTE) without an ILND in patients with T1 clinically node-negative (cN0) SCCP.

We examined CSM rates in cN0 patients with T1G1-3 SCCP, in whom an ILND was not performed, relying on competing-risks analyses.

OBJECTIVE

  • • To quantify and compare cancer-specific mortality (CSM) and other-cause mortality (OCM) in individuals with stage T1G1–3 clinically node-negative (cN0) squamous cell carcinoma of the penis (SCCP) since there is no consensus regarding the need for an inguinal lymph node dissection (ILND) in patients with T1G2–3 cN0 SCCP.

METHODS

  • • Relying on the Surveillance, Epidemiology and End Results database, we identified 655 patients diagnosed with primary SCCP between 1988 and 2006.
  • • Cumulative incidence plots were used to graphically depict the effect of CSM relative to OCM.
  • • Competing-risks regression analyses were used to quantify the risk of CSM or OCM after adjusting for age, race, tumour grade and surgery type.

RESULTS

  • • The 5-year CSM rates after a primary tumour excision without ILND were 2.6%, 10.0% and 15.9% in patients with respectively T1G1, T1G2 and T1G3 cN0 SCCP.
  • • The 5-year OCM rates were 29.5%, 27.3% and 29.3% in patients with respectively T1G1, T1G2 and T1G3.
  • • Age failed to provide additional stratification.

CONCLUSIONS

  • • The CSM rate was highest in T1G3 patients and appears to justify ILND.
  • • Conversely, the CSM rate was lowest in T1G1 patients, which justifies active surveillance in this patient subset.
  • • A moderate CSM rate at 5 years was recorded for T1G2 patients, which brings into question the benefits of ILND.

Ancillary