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Nazzani S, Catanzaro M, Bruniera M, Torelli T, Macchi A, Stagni S, Tesone A, Silvani C, Ceccato T, Bernasconi V, Lanocita R, Cascella T, Claps M, Giannatempo P, Zimatore M, Cattaneo L, Biasoni D, Montanari E, Nicolai N. Surveillance or Dynamic Sentinel Lymph-Node Biopsy in Low-Risk Clinically N0 Penile Squamous Cell Carcinoma: Single-Institution Real World Data. Clin Genitourin Cancer 2024; 22:544-548. [PMID: 38278655 DOI: 10.1016/j.clgc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Surveillance is the standard management in low-risk cN0 penile squamous cell carcinoma (peSCC) patients. However, no previous analysis focused on early and long-term outcomes of these patients. We report on main oncological outcomes of a large series of low-risk cN0 peSCC patients. PATIENTS AND METHODS Between 1980 and 2017 included, 93 evaluable consecutive low-risk (ie, pT1a G1 cN0M0) peSCC patients underwent primary tumor surgery and either observation (74) or dynamic sentinel node biopsy (DSNB) (19) following a clinical diagnosis of T1 in 66 (71%), T2 in 15 (16.1%) and Tx in 12 (12.9%) patients, respectively. The statistical significance of differences in medians and proportions was tested with the Kruskal-Wallis and chi-square tests. Kaplan-Meier plots illustrated 5-year inguinal relapse (IR)-free survival rates. RESULTS Median age was 60 years (IQR: 50-69 years). Median follow-up was 92 months (IQR 54-133 months). Surveillance was more frequently adopted in clinical (c)T1 than in cT2 tumors (79.7% vs. 36.8%). None of 19 patients who had DSNB had nodal metastasis. Overall, 7 (7.5%) out of 93 pT1aG1cN0 peSCC patients had IR after a median interval of 9 months. Of note, 1 patient only relapsed after 12 months of surveillance. After stratification according to IR, relapses occurred more frequently in younger patients (59 vs. 64 years, P < .001). The 5-year IR-free survival rates for the entire cohort was 92% (95% Confidence interval [CI] 87-98%). CONCLUSIONS Observation is a safe and effective management for low-risk peSCC patients. Younger patients may be offered a mini-invasive staging as an alternative.
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Affiliation(s)
- Sebastiano Nazzani
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Mario Catanzaro
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martina Bruniera
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tullio Torelli
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberto Macchi
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stagni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonio Tesone
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Silvani
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Tommaso Ceccato
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valentina Bernasconi
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Rodolfo Lanocita
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tommaso Cascella
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Melanie Claps
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Giannatempo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Zimatore
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Cattaneo
- Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Biasoni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuele Montanari
- Università degli Studi di Milano, Milan, Italy; Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Nicola Nicolai
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Testis surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Sarcan S, Wolff I, Lusuardi L, Kravchuk A, Wiegland J, Yakac A, Thomas C, Burger M, Gilfrich C, Lebentrau S, Ahyai S, Merseburger A, May M. The landscape of penile cancer research in Germany and Austria: a survey among professors in academic centers holding chair positions and results of a literature search. World J Urol 2024; 42:12. [PMID: 38189947 DOI: 10.1007/s00345-023-04719-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Research on penile cancer (PeCa) is predominantly conducted in countries with centralized treatment of PeCa-patients. In Germany and Austria (G + A), no state-regulated centralization is established, and no information is available on how PeCa-research is organized. METHODS Current research competence in PeCa was assessed by a 36-item questionnaire sent to all chairholders of urological academic centers in G + A. Based on PubMed records, all scientific PeCa-articles of 2012-2022 from G + A were identified. Current research trends were assessed by dividing the literature search into two periods (P1: 2012-2017, P2: 2018-2022). A bibliometric analysis was supplemented. RESULTS Response rate of the questionnaire was 75%, a median of 13 (IQR: 9-26) PeCa-patients/center was observed in 2021. Retrospective case series were conducted by 38.9% of participating clinics, while involvement in randomized-controlled trials was stated in 8.3% and in basic/fundamental research in 19.4%. 77.8% declared an interest in future multicenter projects. 205 PeCa-articles were identified [median impact factor: 2.77 (IQR: 0.90-4.37)]. Compared to P1, P2 showed a significant increase in the median annual publication count (29 (IQR: 13-17) vs. 15 (IQR: 19-29), p < 0.001), in multicenter studies (79.1% vs. 63.6%, p = 0.018), and in multinational studies (53% vs. 28.9%, p < 0.001); the proportion of basic/fundamental research articles significantly declined (16.5% vs. 28.9%, p = 0.041). Four of the top-5 institutions publishing PeCa-articles are academic centers. Bibliometric analyses revealed author networks, primary research areas in PeCa, and dominant journals for publications. CONCLUSIONS Given the lack of centralization in G + A, this analysis highlights the need for research coordination within multicenter PeCa-projects. The decline in basic/fundamental research should be effectively addressed by the allocation of funded research projects.
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Affiliation(s)
- Semih Sarcan
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Lukas Lusuardi
- Department of Urology and Andrology, Paracelsus Medical University, Salzburg, Austria
| | - Anton Kravchuk
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Jens Wiegland
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Abdulbaki Yakac
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | - Christian Gilfrich
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Steffen Lebentrau
- Department of Urology, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
- Department of Urology, Werner Forssmann Hospital, Eberswalde, Germany
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Axel Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany.
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Hakenberg O, Dräger DL. [Systemic treatment of penile cancer: New concepts? New achievements?]. Aktuelle Urol 2023; 54:304-312. [PMID: 37541237 DOI: 10.1055/a-2104-1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Systemic chemotherapy has been in use for metastatic penile carcinoma for years, but its success is limited. Its significance is largely associated with its role in multimodal treatment for lymphatic metastasis in the context of radical lymph node surgery. In cases of limited lymph node involvement, the combination of surgical treatment plus cisplatin- and taxane-based triple combinations may be curative. Advances in the understanding of molecular changes in penile cancer and the search for potential therapy targets have led to numerous studies. Although there is evidence of efficacy of immunotherapeutics, no significant therapeutic improvements have been seen in the clinical routine.
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Ulvskog E, Persson EK, Kirrander P, Fall K, Ahlgren J. Nationwide Data Support Centralised Decision-making in Penile Cancer Care: A Before-and-After Study on Guideline Adherence and Disease-specific survival for Patients with an Indication for Perioperative Oncological Treatment. EUR UROL SUPPL 2023; 51:70-77. [PMID: 37187721 PMCID: PMC10175737 DOI: 10.1016/j.euros.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 04/03/2023] Open
Abstract
Background The benefit of perioperative oncological treatment in men with penile cancer is uncertain. In 2015, treatment recommendations were centralised in Sweden and treatment guidelines were updated. Objective To evaluate if the use of oncological treatment in men with penile cancer increased after the introduction of centralised recommendations, and whether such therapy is associated with better survival. Design setting and participants This was a retrospective cohort study including a total of 426 men diagnosed with penile cancer with lymph node or distant metastases in Sweden during 2000-2018. Outcome measurements and statistical analysis We first assessed the change in the proportion of patients with an indication for perioperative oncological treatment who actually received such treatment. Second, we used Cox regression to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-specific mortality associated with perioperative treatment. Comparisons were made for both all men without perioperative treatment and for those who did not receive treatment but who lacked apparent contraindications for treatment. Results and limitations The use of perioperative oncological treatment increased from 2000 to 2018, from 32% of patients with an indication for treatment during the first 4 yr to 63% during the last 4 yr. In comparison to patients potentially eligible for oncological treatment who did not receive it, those who were treated had a 37% lower risk of disease-specific death (HR 0.63, 95% CI 0.40-0.98). Stage migration because of improvements in diagnostic tools over time may have inflated the more recent survival estimates. An influence of residual confounding due to comorbidity and other potential confounders cannot be excluded. Conclusions The use of perioperative oncological treatment increased after the centralisation of penile cancer care in Sweden. Although the observational study design precludes causal inference, the findings suggest that perioperative treatment in patients with penile cancer eligible for treatment may be associated with better survival. Patient summary In this study, we looked at the use of chemotherapy and radiotherapy for men with penile cancer and lymph node metastases in Sweden during 2000-2018. We found an increase in the use of cancer therapy and an increase in survival for patients who received such therapy.
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Thomas A, Kölling F, Haferkamp A, Tsaur I. [Quality of care criteria in the treatment of penile cancer]. Urologe A 2021; 60:186-192. [PMID: 33452551 DOI: 10.1007/s00120-020-01429-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Penile cancer is a rare malignancy and the wide range of quality of care associated with it often results in inferior oncologic and functional treatment outcomes. OBJECTIVES Assessment of the current healthcare situation in clinical routine and identification of the relevant key features and reference values for quality of care. MATERIALS AND METHODS Search for relevant peer-reviewed articles and published congress abstracts in Medline, Embase and other databases as well as Google web search engine. RESULTS Key quality features of penile cancer management include organ-sparing surgery of the primary tumor, invasive inguinal lymph node staging and systemic treatment. Adherence to treatment guidelines is currently low. Centralization of care has already led to a considerable improvement in the quality of care in some areas and increasing conformity with the guidelines' recommendations. CONCLUSION Centralization of care and networks based on this can significantly improve patient outcomes. Thus, reference values for core parameters of quality cancer care can be generated and validated. Moreover, organ-sparing surgery, invasive lymph node staging and systemic therapy should be increasingly utilized. As a reference value, 90% adherence to the guidelines for these three features is recommended. However, before centralization of care can be introduced, aspects relevant to practical implementation must be addressed, such as the reimbursement of travel costs for those affected, infrastructure costs and instruments to measure quality of life and patient satisfaction after centralization.
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Affiliation(s)
- A Thomas
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - F Kölling
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - A Haferkamp
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - I Tsaur
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Cakir OO, Castiglione F, Tandogdu Z, Collins J, Alnajjar HM, Akers C, Albersen M, Alifrangis C, Ayres B, Brouwer O, Cullen I, Hawkey P, Jakobsen JK, Johansen TEB, Kalejaiye O, Kaul A, Köves B, Kumar V, Mancini M, Mitra AV, Parnham A, Pozzi E, Protzel C, Sangar VK, Wagenlehner F, Muneer A. Management of penile cancer patients during the COVID-19 pandemic: An eUROGEN accelerated Delphi consensus study. Urol Oncol 2021; 39:197.e9-197.e17. [PMID: 33397593 PMCID: PMC7831701 DOI: 10.1016/j.urolonc.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 12/02/2022]
Abstract
Objectives To develop an international consensus on managing penile cancer patients during the COVID-19 acute waves. A major concern for patients with penile cancer during the coronavirus disease 2019 (COVID-19) pandemic is how the enforced safety measures will affect their disease management. Delays in diagnosis and treatment initiation may have an impact on the extent of the primary lesion as well as the cancer-specific survival because of the development and progression of inguinal lymph node metastases. Materials and methods A review of the COVID-19 literature was conducted in conjunction with analysis of current international guidelines on the management of penile cancer. Results were presented to an international panel of experts on penile cancer and infection control by a virtual accelerated Delphi process using 4 survey rounds. Consensus opinion was defined as an agreement of ≥80%, which was used to reconfigure management pathways for penile cancer. Results Limited evidence is available for delaying penile cancer management. The consensus rate of agreement was 100% that penile cancer pathways should be reconfigured, and measures should be developed to prevent perioperative nosocomial transmission of COVID-19. The panel also reached a consensus on several statements aimed at reconfiguring the management of penile cancer patients during the COVID-19 pandemic. Conclusions The international consensus panel proposed a framework for the diagnostic and invasive therapeutic procedures for penile cancer within a low-risk environment for COVID-19.
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Affiliation(s)
- Omer Onur Cakir
- Department of Urology, University College London Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom
| | - Fabio Castiglione
- Department of Urology, University College London Hospital, London, United Kingdom; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Zafer Tandogdu
- Department of Urology, University College London Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom
| | - Justin Collins
- Department of Urology, University College London Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom
| | - Hussain M Alnajjar
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Clare Akers
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Constantine Alifrangis
- Department of Medical Oncology St Bartholomews Hospital, London, United Kingdom; NIHR Biomedical Research Centre, University College London Hospital, London, United Kingdom
| | - Benjamin Ayres
- Department of Urology, St George's University Hospitals, London, United Kingdom
| | - Oscar Brouwer
- Department of Surgical Oncology, Netherlands Cancer Institute, The Netherlands
| | - Ivor Cullen
- National Cancer Control Programme, University Hospital Waterford, Ireland
| | - Peter Hawkey
- Institute of Microbiology and Infection, University of Birmingham, United Kingdom
| | | | - Truls Erik Bjerklund Johansen
- Department of Urology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Institute of Clinical Medicine, University of Aarhus, Denmark
| | - Odunayo Kalejaiye
- Department of Urology, University Hospitals Birmingham, United Kingdom
| | - Asheesh Kaul
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Bela Köves
- Department of Urology, South Pest Hospital, Budapest, Hungary
| | - Vivekanandan Kumar
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | | | - Anita Vanessa Mitra
- Department of Clinical Oncology, University College London Hospital, London, United Kingdom
| | - Arie Parnham
- Department of Urology, The Christie NHS Trust, Manchester, United Kingdom
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chris Protzel
- Department of Urology, Helios Kliniken Schwerin Medical School MSH, Germany
| | - Vijay K Sangar
- Department of Urology, The Christie NHS Trust, Manchester, United Kingdom; Department of Urology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Asif Muneer
- Department of Urology, University College London Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom; NIHR Biomedical Research Centre, University College London Hospital, London, United Kingdom.
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