Penile CancerRecurrence Patterns of Squamous Cell Carcinoma of the Penis: Recommendations for Follow-Up Based on a Two-Centre Analysis of 700 Patients
Introduction
Penile carcinoma is a rare disease in the Western world, with an incidence ranging from 0.1 to 2.2 per 100 000 males [1], [2]. The low prevalence presents a challenge for scientific research, and, consequently, most studies are hampered by small numbers of patients. Additionally, the majority of reports are single-institutional experiences.
The main aim in oncological treatment is to eradicate cancer with minimal morbidity to the patient. Besides adequate treatment of the disease, accurate follow up is essential. Ideally, a follow-up schedule should give the opportunity to detect a tumour recurrence in the earliest stage while causing the least possible burden to the patient and health care system. Therefore, it is important to have insight into the recurrence patterns of the disease. However, only few data regarding this issue are available for penile carcinoma.
In this retrospective analysis of 700 patients from two referral centres, we evaluate the recurrence patterns of penile carcinoma in different treatment settings and provide recommendations for follow up based on the findings.
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Methods
The recorded data of 747 patients from two referral centres for penile carcinoma were combined. The database from The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital (NKI-AVL) contained 545 patients treated in the period from 1956 until January 2006. The database from Örebro University Hospital in Sweden contained 202 patients treated in the period from 1984 until March 2007.
Results
An overview of patient characteristics can be found in Table 1. The median time of follow up for all patients was 60.6 mo (range 3–358 mo). The 5-yr disease-specific survival was 82.4% (95% CI, 79.3%–85.7%) for the entire group of patients.
A total of 205 out of 700 patients (29.3%) had a recurrence during the entire period of follow up, consisting of 109 (15.6%) patients with a local, 65 (9.3%) patients with a regional, and 10 (1.4%) patients with a distant recurrence. Eighteen patients had a
Discussion
This study gives detailed insight into the recurrence patterns of penile carcinoma in different treatment settings and their impact on survival.
Penile-preserving treatment has an increasingly important role in the management of penile carcinoma, as the quality of life is influenced by the type of surgery performed [7], [8], [9]. The risk of a local recurrence is higher when using penile-preserving methods. However, despite the high number of local recurrences after penile-preserving treatment
Conclusions
We recommend a maximum follow up of 5 disease-free yr. Of the total recurrences, 74.1% occur during the first 2 yr; hence, the more intense interval of follow up. During the first 2 yr, we recommend a 3-mo follow-up interval for patients undergoing penile-preserving therapy and a 6-mo interval for patients undergoing a penile amputation. The role of patient self-examination should be emphasized.
Regarding the follow up of the regional lymph nodes during the initial 2 yr, we advise a more intense
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