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. 2021 Oct;39(10):736.e1-736.e7.
doi: 10.1016/j.urolonc.2021.06.020. Epub 2021 Jul 21.

Penile-sparing surgery for patients with superficial or initially invasive squamous cell carcinoma of the penis: long-term oncological outcomes

Stefano Luzzago  1 , Alessandro Serino  2 , Gaetano Aurilio  3 , Francesco A Mistretta  4 , Mattia Luca Piccinelli  2 , Vito Lorusso  2 , Michele Morelli  2 , Roberto Bianchi  4 , Michele Catellani  4 , Gabriele Cozzi  4 , Ettore Di Trapani  4 , Antonio Cioffi  4 , Elena Verri  3 , Matteo Ferro  4 , Maria Cossu Rocca  3 , Deliu-Victor Matei  4 , Franco Nolè  3 , Ottavio de Cobelli  5 , Gennaro Musi  5
Affiliations

Penile-sparing surgery for patients with superficial or initially invasive squamous cell carcinoma of the penis: long-term oncological outcomes

Stefano Luzzago et al. Urol Oncol. 2021 Oct.

Abstract

Purpose: To report long-term oncological outcomes after penile-sparing surgery (PSS) for superficial (Ta-Tis) or initially invasive (T1) penile cancer patients.

Methods: We retrospectively analysed 85 patients with Ta/Tis/T1cN0cM0 penile cancer (1996-2018). All patients underwent PSS: circumcision, excision or laser ablation. First, Kaplan-Meier plots and multivariable Cox regression models tested tumor recurrence rates (any local/regional/metastatic). Second, Kaplan-Meier plots depicted progression-free survival (≥T2 or N1-3 or M1 disease).

Results: Median (IQR) follow-up time was 64 (48-95) months. Overall, 48 (56%) patients experienced tumor recurrence. Median (IQR) time to tumor recurrence was 34 (7-52) months. Higher recurrence rates were observed for Tis (65%) and T1 (64%), compared to Ta (40%), but these differences were not significant on multivariable Cox regression analyses (HR:2.0 with 95% CI [0.9-5.1] and HR:2.2 with 95% CI [0.9-5.9], respectively). Moreover, higher recurrence rates were observed for G2-3 tumors (74%), compared to G1 (57%), but these differences were not significant on multivariable Cox regression analyses (HR:1.6; 95% CI [0.8-3.2]). During follow-up, 15 (17.5%) vs. 18 (21.2%) vs. 10 (11.5%) patients underwent 1 vs. 2 vs. ≥3 PSS. Moreover, 26 (30.6%) and 4 (4.7%) men were treated with glansectomy and partial/total penile amputation due to local progression, tumor size or patient preference. Additionally, 24 (28%) men underwent invasive nodal staging. Last, 22 (25.9%) patients experienced disease progression. Median (IQR) time to disease progression was 51 (31-82) months.

Conclusion: Patients treated with PSS for newly diagnosed superficial or initially invasive squamous cell carcinoma of the penis should be informed about the non-negligible risk of tumor recurrence and disease progression over time. In consequence, strict follow-up protocols are needed.

Keywords: Circumcision; Excision; Laser ablation; Penile cancer; Penile-sparing surgery.

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