National Trends and Predictors of Organ-sparing for Invasive Penile Tumors: Expanding the Therapeutic Window

Current guidelines for the management of lower stage penile tumors advocate for organ-sparing whenever oncologically feasible. In this study, we aim to analyze current national trends in organ-sparing treatment as well as evaluate predictors influencing local treatment management. In total, 49% (2073 of 4172) of patients received organ-sparing treatment over the study period (P = .009). Demographic and socioeconomic differences were found as predictors in treatment management for these patients. In a subgroup analysis of pT2 patients, older age, black race, comorbidity, node status, and grade were associated with increased overall mortality, whereas organ-sparing did not have an effect (hazard ratio, 0.83; 95% confidence interval, 0.52-1.31) in these patients. More studies are needed to evaluate the oncologic efficacy in select, invasive penile tumors. Introduction: The purpose of this study was to analyze contemporary trends and predictors in the use of organsparing treatment (OST) for low-stage invasive penile tumors as well as to ascertain its impact on overall mortality (OM) in those with high-risk (pT2) disease. Patients and Methods: The National Cancer Data Base was queried for patients with clinically nonmetastatic penile cancer and available pathologic tumor (pT) and treatment data from 1998 to 2012. Independent predictors for performance of OST were analyzed. Multivariable Cox proportional hazard regression was used to identify factors of OM in a subset of patients with pT2 disease. Results: A total of 4231 patients with <= pT2cN0cM0 primary penile cancer were identified over a median follow-up of 39.6 months. Approximately 49% of patients received OST over the study period (P=.009). Older age, Hispanic ethnicity, urban counties, academic facilities, and pT2 disease were negative predictors for OST (all P<.05), whereas grade and years of diagnosis where associated with increased performance (P<.01). In subgroup analysis of pT2 patients, older age, black race, comorbidity, node status, and grade were associated with higher OM (all P<.05). When compared with radical penectomy, partial penectomy was associated with decreased OM (hazard ratio, 0.67; 95% confidence interval, 0.52-0.87; P=.002), whereas organ-sparing did not affect survival (hazard ratio, 0.83; 95% confidence interval, 0.52-1.31; P=.419) in these patients. Conclusion: Ethnic and socioeconomic differences exist in the local management of penile tumors. No impact on OM was observed for those with high-risk cases treated with organ-sparing at intermediate follow-up. More studies are needed to evaluate oncologic efficacy of organ-sparing in carefully selected invasive penile tumors. (C) 2017 Elsevier Inc. All rights reserved.