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.
- • 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.
- • 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.
- • 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.
- • 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.