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Yakac A, Lebentrau S, Lusuardi L, Sarcan S, Burger M, Merseburger AS, Wiegland J, Gilfrich C, Wolff I, Ahyai S, May M, Thomas C. Centralizing Penile Cancer Care in Germany and Austria: Just a Dream or a Fast-Approaching Reality? Results of a Survey Study among Urological Department Chairs and Modeling of Real Treatment Numbers of Penile Cancer Patients. Urol Int 2023; 107:916-923. [PMID: 37918360 DOI: 10.1159/000534089] [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: 07/18/2023] [Accepted: 09/02/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION In countries characterized by a centralization of therapy management, patients with penile cancer (PeCa) have shown improvements in guideline adherence and ultimately, improved carcinoma-specific survival. Germany and Austria (G + A) have no state-regulated centralization of PeCa management, and the perspectives of urological university department chairs (UUDCs) in these countries, who act as drivers of professional and political developments, on this topic are currently unknown. METHODS Surveys containing 36 response options, including specific questions regarding perspectives on PeCa centralization, were sent to the 48 UUDC in G + A in January 2023. In addition to analyzing the responses, closely following the CROSS checklist, a modeling of the real healthcare situation of in-house PeCa patients in G + A was conducted. RESULTS The response rate was 75% (36/48). 94% and 89% of the UUDCs considered PeCa centralization meaningful and feasible in the medium term, respectively. Among the UUDCs, 72% estimated centralization within university hospitals as appropriate, while 28% favored a geographically oriented approach. Additionally, 97% of the UUDCs emphasized the importance of bridging the gap until implementation of centralization by establishing PeCa second-opinion portals. No country-specific differences were observed. The median number of in-house PeCa cases at the university hospitals in G + A was 13 (interquartile range: 9-26). A significant positive correlation was observed between the annual number of in-house PeCa cases at a given university hospital and the perspective of the UUDCs that centralization as meaningful by its UUDC (0.024). Under assumptions permissible for modeling, the average number of in-house PeCa cases in academic hospitals in G + A was approximately 30 times higher than in nonacademic hospitals. CONCLUSION This study provides the first data on the perspectives of UUDCs in G + A concerning centralization of PeCa therapy management. Even without state-regulated centralization in G + A, there is currently a clear focusing of PeCa treatments in university hospitals. Further necessary steps toward a structured PeCa centralization are discussed in this manuscript.
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Affiliation(s)
- Abdulbaki Yakac
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Steffen Lebentrau
- Department of Urology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Department of Urology, Werner Forssmann Hospital, Eberswalde, Germany
| | - Lukas Lusuardi
- Department of Urology and Andrology, Paracelsus Medical University, Salzburg, Austria
| | - Semih Sarcan
- Department of Urology, University Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Axel S Merseburger
- Department of Urology, University Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Jens Wiegland
- St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Christian Gilfrich
- St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Sascha Ahyai
- Department of Urology, University of Graz, Graz, Austria
| | - Matthias May
- St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Christian Thomas
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Mink JN, Khalmurzaev O, Pryalukhin A, Hölters S, Geppert C, Lohse S, Bende K, Lobo J, Henrique R, Loertzer H, Steffens J, Jerónimo C, Wunderlich H, Heinzelbecker J, Bohle R, Stöckle M, Matveev V, Hartmann A, Junker K. [Importance of HPV status and p16 for the prognosis of penile carcinoma]. Aktuelle Urol 2023; 54:274-284. [PMID: 37541236 DOI: 10.1055/a-2104-1270] [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
BACKGROUND Penile cancer is a rare but often lethal tumour disease, especially in the metastatic stage. Most data on prognostic factors for penile cancer are based on small patient cohorts, and even meta-analyses are mostly limited in terms of patient numbers. There is a lack of sufficient parameters to predict the metastatic risk of these tumours. Furthermore, the role of the HPV status for the prognosis, and, in this regard, of p16INK4a is still unclear. MATERIAL AND METHODS In this study, 236 patients from an international multicentre cohort were analysed with regard to histological subtypes, HPV and p16 status, and other clinical parameters. The HPV status was only graded as HPV-positive if HPV was detected by PCR and the p16 status defined by immunochemistry was positive. The statistical analysis was carried out using the Kaplan-Meier method as well as the log-rank test and a univariable and multivariable analysis using the Cox regression model. RESULTS A positive HPV status was not a significant parameter for either metastasis-free (MFS), tumour-specific (CSS) or overall survival (OS). p16-positive tumours showed a significantly better MFS (p=0.026), which was also confirmed in the subgroup analysis of HPV-negative tumours (p=0.037) without differences in CSS or OS. In the usual type, there was also a trend towards an improved MFS, but without statistical significance (p=0.070). p16-positive tumours were associated with a highly significantly better MFS (hazard ratio 0.3; p=0.004) in the multivariable Cox regression, while patients with a pT1b tumour stage or advanced lymph node metastasis showed a significantly worse survival. In the multivariable analysis of HPV-negative tumours, p16 status was also confirmed as an independent predictor of MFS (Hazard ratio 0.2; p=0.007). CONCLUSION HPV status alone seems to be lacking prognostic relevance. In contrast, p16 status was confirmed as an independent prognostic factor. Thus, the expression of p16INK4a is associated with a significantly better MFS. Especially in HPV-negative tumours, the p16 status should be evaluated with regard to the prognostic value and thus also with a view to the treatment decision.
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Affiliation(s)
- Jan Niklas Mink
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Oybek Khalmurzaev
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
- Abteilung für Urologie, N N Blokhin NMRCO, Moskva, Russian Federation
| | - Alexey Pryalukhin
- Abteilung für Pathologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
- Institut für Pathologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Sebastian Hölters
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Carol Geppert
- Institut für Pathologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Stefan Lohse
- Abteilung für Virologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Kristof Bende
- Institut für Pathologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - João Lobo
- Abteilung für Pathologie, IPO-PORTO, Porto, Portugal
| | - Rui Henrique
- Abteilung für Pathologie, IPO-PORTO, Porto, Portugal
| | - Hagen Loertzer
- Abteilung für Urologie und Kinderurologie, Westpfalz Klinikum Gmbh, Kaiserslautern, Deutschland
| | - Joachim Steffens
- Klinik für Urologie und Kinderurologie, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Carmen Jerónimo
- Abteilung für Pathologie, IPO-PORTO, Porto, Portugal
- Portuguese Oncology Institute of Porto, Research Center (CI-IPOP), Porto
| | - Heiko Wunderlich
- Abteilung für Urologie und Kinderurologie, St. Georg Klinikum Eisenach, Eisenach, Deutschland
| | - Julia Heinzelbecker
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Rainer Bohle
- Abteilung für Pathologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Michael Stöckle
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Vsevolod Matveev
- Abteilung für Urologie, N N Blokhin NMRCO, Moskva, Russian Federation
| | - Arndt Hartmann
- Institut für Pathologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Kerstin Junker
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
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Lebentrau S, Wakileh GA, Schostak M, Schmid HP, Suarez-Ibarrola R, Merseburger AS, Hutterer GC, Necknig UH, Rink M, Bögemann M, Kluth LA, Pycha A, Burger M, Brookman-May SD, Bründl J, May M. Does the Identification of a Minimum Number of Cases Correlate With Better Adherence to International Guidelines Regarding the Treatment of Penile Cancer? Survey Results of the European PROspective Penile Cancer Study (E-PROPS). Front Oncol 2021; 11:759362. [PMID: 34912711 PMCID: PMC8667688 DOI: 10.3389/fonc.2021.759362] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background Penile cancer represents a rare malignant disease, whereby a small caseload is associated with the risk of inadequate treatment expertise. Thus, we hypothesized that strict guideline adherence might be considered a potential surrogate for treatment quality. This study investigated the influence of the annual hospital caseload on guideline adherence regarding treatment recommendations for penile cancer. Methods In a 2018 survey study, 681 urologists from 45 hospitals in four European countries were queried about six hypothetical case scenarios (CS): local treatment of the primary tumor pTis (CS1) and pT1b (CS2); lymph node surgery inguinal (CS3) and pelvic (CS4); and chemotherapy neoadjuvant (CS5) and adjuvant (CS6). Only the responses from 206 head and senior physicians, as decision makers, were evaluated. The answers were assessed based on the applicable European Association of Urology (EAU) guidelines regarding their correctness. The real hospital caseload was analyzed based on multivariate logistic regression models regarding its effect on guideline adherence. Results The median annual hospital caseload was 6 (interquartile range (IQR) 3–9). Recommendations for CS1–6 were correct in 79%, 66%, 39%, 27%, 28%, and 28%, respectively. The probability of a guideline-adherent recommendation increased with each patient treated per year in a clinic for CS1, CS2, CS3, and CS6 by 16%, 7.8%, 7.2%, and 9.5%, respectively (each p < 0.05); CS4 and CS5 were not influenced by caseload. A caseload threshold with a higher guideline adherence for all endpoints could not be perceived. The type of hospital care (academic vs. non-academic) did not affect guideline adherence in any scenario. Conclusions Guideline adherence for most treatment recommendations increases with growing annual penile cancer caseload. Thus, the results of our study call for a stronger centralization of diagnosis and treatment strategies regarding penile cancer.
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Affiliation(s)
- Steffen Lebentrau
- Department of Urology, Werner Forßmann Hospital, Eberswalde, Germany
| | | | - Martin Schostak
- Department of Urology and Urooncology, University Medical Center Magdeburg, Magdeburg, Germany
| | - Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Axel S Merseburger
- Department of Urology, University of Schleswig-Holstein, Lübeck, Germany
| | - Georg C Hutterer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Ulrike H Necknig
- Department of Urology and Pediatric Urology, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Bögemann
- Department of Urology and Pediatric Urology, University Medical Center Münster, Münster, Germany
| | - Luis Alex Kluth
- Department of Urology, University Medical Center Frankfurt a.M., Frankfurt/Main, Germany
| | - Armin Pycha
- Department of Urology, Hospital of Bolzano, Bolzano-Bozen, Italy.,Medical School, Sigmund Freud University Vienna, Vienna, Austria
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Sabine D Brookman-May
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Matthias May
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.,Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
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