Elsevier

European Urology

Volume 54, Issue 1, July 2008, Pages 161-169
European Urology

Penile Cancer
Recurrence Patterns of Squamous Cell Carcinoma of the Penis: Recommendations for Follow-Up Based on a Two-Centre Analysis of 700 Patients

https://doi.org/10.1016/j.eururo.2008.04.016Get rights and content

Abstract

Background

Current follow-up recommendations for patients with penile carcinoma are based on small numbers of patients.

Objectives

To give further insight into the recurrence patterns of penile carcinoma in different treatment settings and provide recommendations for follow up.

Designs, Setting, and Participants

In this retrospective study, we analysed 700 patients from two referral centres for penile carcinoma for recurrences.

Measurements

Recurrences were categorized as local, regional, or distant. The rate of local recurrences was compared between patients undergoing penile-preserving treatments and partial/total amputation. Regional recurrences were compared between patients surgically staged as pN0 or pN+ and clinically node-negative (cN0) patients subjected to a wait-and-see policy. The total recurrence rate, type of recurrence, time to recurrence, and survival were calculated.

Results and Limitations

205 out of 700 patients (29.3%) had a recurrence, consisting of 18.6% local, 9.3% regional, and 1.4% distant recurrences. Of the recurrences, 92.2% occurred within 5 yr after primary treatment. All regional and distant recurrences occurred within 50 and 16 mo, respectively. The local recurrence rate was 27.7% after penile-preserving therapy and 5.3% after amputation. The regional recurrence rate was 2.3% in patients staged as pN0, 19.1% in patients staged as pN+, and 9.1% in patients undergoing a wait-and-see policy. The 5-yr disease-specific survival was 92% after a local recurrence and 32.7% after a regional recurrence. All patients with a distant recurrence died within 22 mo. Although the number of analysed patients is substantial, the results do not necessarily reflect those of other centres using different techniques for the management of penile carcinoma.

Conclusions

Patients undergoing penile-preserving therapy, patients surgically staged as pN+, and those undergoing a wait-and-see policy for the nodal status are at high risk of developing a recurrence. Follow-up recommendations are provided based on the risk and impact on survival of a recurrence.

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.

Section snippets

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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