Impact of pathologic features on local recurrence in penile squamous cell carcinoma after penectomy

Area of Science:

• Oncology
• Surgical Pathology
• Urologic Oncology

Background:

• Penile squamous cell carcinoma (PSCC) is a rare cancer.
• Local recurrence (LR) risk factors after penectomy are not well-defined.
• This study examines LR predictors and margin assessment impact in PSCC patients undergoing penectomy.

Purpose of the Study:

• To identify risk factors for local recurrence (LR) in patients with penile squamous cell carcinoma (PSCC) after partial or radical penectomy.
• To evaluate the impact of intraoperative frozen margin assessment on final margin status and subsequent LR.
• To describe patterns of LR and the importance of margin status in PSCC management.

Main Methods:

• Retrospective review of 119 patients with PSCC undergoing partial or radical penectomy (2007-2023).
• Analysis of clinical and pathological features to determine LR predictors using statistical methods (t-test, Fisher's exact, chi-square, logistic regression).
• Assessment of frozen margin accuracy and LR rates based on margin status.

Main Results:

• Local recurrence (LR) occurred in 6.7% of patients.
• No statistically significant predictors of LR were identified, though positive final margins showed a trend toward increased risk.
• Frozen margin analysis had 44% sensitivity and 92% specificity for predicting final positive margins; no LR occurred when frozen margins were not sent.

Conclusions:

• Local recurrence (LR) is uncommon following penectomy for PSCC, even for larger tumors.
• While no significant LR predictors were found, achieving negative margins intraoperatively is a strong indicator of low LR risk.
• For CIS or focally positive margins, aggressive resection may not significantly reduce clinically relevant LR; bulky disease management should prioritize palliation and subsequent therapies.