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. 2020 Jun;125(6):867-875.
doi: 10.1111/bju.15054. Epub 2020 Apr 1.

Optimising the selection of candidates for neoadjuvant chemotherapy amongst patients with node-positive penile squamous cell carcinoma

Marco Bandini  1 , Maarten Albersen  2 , Juan Chipollini  3 , Filippo Pederzoli  1 , Yao Zhu  4 , Ding-Wei Ye  4 , Antonio A Ornellas  5 , Nick Watkin  6 , Michael Ager  6 , Oliver W Hakenberg  7 , Axel Heidenreich  8 , Daniele Raggi  9 , Mario Catanzaro  9 , Friederike Haidl  8 , Elio Mazzone  1 , Laura Marandino  9 , Alberto Briganti  1 , Francesco Montorsi  1 , Mounsif Azizi  3 , Philippe E Spiess  3 , Andrea Necchi  7
Affiliations

Optimising the selection of candidates for neoadjuvant chemotherapy amongst patients with node-positive penile squamous cell carcinoma

Marco Bandini et al. BJU Int. 2020 Jun.

Abstract

Objectives: To identify predictors of poor overall survival (OS) amongst patients with penile squamous cell carcinoma (pSCC) with clinical inguinal lymphadenopathy (cN+), in order to define the best candidates for neoadjuvant chemotherapy (NAC).

Patients and methods: Using an international, multicentre database of 924 patients with pSCC, we identified 334 men who harboured cN+ with available clinical and follow-up data. Lymph node involvement was defined either by the presence of palpable inguinal node disease or by preoperative computed tomography (CT) assessment. Fluorine-18 fluorodeoxyglucose positron-emission tomography (18 F-FDG-PET)/CT scan was performed based on clinical judgment of the treating physician. Regression-tree analysis generated a risk stratification tool for prediction of 24-month overall mortality (OM). Kaplan-Meier explored the OS benefit related to the use of NAC according to the regression-tree-stratified subgroups.

Results: Overall, 120 (35.9%), 152 (45.5%), and 62 (18.6%) patients harboured cN1, cN2, and cN3 disease. 18 F-FDG-PET/CT was performed in 48 (14.4%) patients, and 16 (4.8%) had inguinal and pelvic nodal PET detection. The median OS was 107 months, with a 24-month OS of 66%. At regression-tree analysis (area under the curve = 70%), patients with cN3 and cN2 with PET/CT-detected inguinal and pelvic nodal activity had a higher risk of 24-month OM (>50%). NAC was associated with improved 24-month OS rates (54% vs 33%) only in this subgroup of patients (P = 0.002), which was also confirmed after multivariable adjustment (hazard ratio 0.28, 95% confidence interval 0.13-0.62; P = 0.002).

Conclusion: Patients with pSCC with cN3 or cN2 and inguinal and pelvic 18F-FDG-PET/CT scan detected disease had higher 24-month OM rates according to our regression-tree model. NAC was associated with improved OS only in these subgroups of patients. Our novel decision model may help to stratify cN+ patients, and identify those who most likely will benefit from NAC prior to radical surgical resection.

Keywords: neoadjuvant chemotherapy; patient selection; penile cancer; regression-tree; squamous cell carcinoma.

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References

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