Treatment Trends for Lymph Node–Positive Penile Cancer


Key Points

  • Overall, lymph node dissection was performed in 67% of patients.
  • Chemotherapy was used in 48% of patients in 2014. 

In a study of data from the National Cancer Database reported in JAMA Oncology, Joshi et al found that two-thirds of patients with node-positive nonmetastatic squamous cell carcinoma of the penis received lymph node dissection and approximately half received chemotherapy in recent years. 

National Comprehensive Cancer Network guidelines support lymph node dissection or radiotherapy with consideration of perioperative chemotherapy for patients with node-positive nonmetastatic disease.

Treatment Trends

The study involved data from 1,123 men diagnosed between January 2004 and December 2014. Of these, 82% were white and 65% were aged between 50 and 75 years.

Overall, lymph node dissection was performed in 727 patients (67%). The use of systemic chemotherapy increased from 38% of patients in 2004 to 48% in 2014 (P < .001); overall, chemotherapy was used in 31% of 338 patients with N1 disease, 40% of 450 with N2 disease, and 53% of 335 with N3 disease.

Chemotherapy use did not differ among patients receiving vs not receiving lymph node dissection (40.4% vs 42.4%, P = .53). In adjusted analysis, older patients were less likely to receive chemotherapy (odd ratio [OR] = 0.28, P <.001, for age > 76 years). Patients who received radiotherapy (OR = 4.38, P < .001), those with N2 disease (OR = 1.62, P = .005), and those with N3 disease (OR = 2.32, P < .001) were more likely to receive chemotherapy.

On multivariate analysis, receipt of lymph node dissection (hazard ratio [HR] = 0.64, P < .001), but not chemotherapy (HR = 1.01, P = .95) or radiotherapy (HR = 0.85, P = .11) was associated with significantly improved overall survival.

The investigators concluded, “In hospitals reporting to the [National Cancer Database], only 66.8% of patients with [lymph node–positive] penile cancer received [lymph node dissection]. While chemotherapy use has increased since 2004, rates remain low (52.8% for patients with N3 cancer). Receipt of [lymph node dissection], but not chemotherapy or radiotherapy, is associated with overall survival. This may reflect the aggressive natural history of penile cancer as well as the inherent analysis limitation of a relatively small sample size. These data highlight opportunities to improve adherence to guideline-recommended care.”

Shreyas S. Joshi, MD, of the Department of Surgical Oncology, Fox Chase Cancer Center, Temple Health, is the corresponding author for the JAMA Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.