Survival benefit and utilization disparities of lymph node dissection in clinically node-negative T2+ penile squamous
Hangcheng Fu1, Abigail George1, Uzoma Anele1
1Department of Urology, University of Louisville School of Medicine, Louisville, KY, United States.
Introduction:
Penile squamous cell carcinoma (PSCC), although rare, presents significant morbidity. Current guidelines recommend lymph node dissection (LND) or lymph node biopsy on a risk-stratified basis for intermediate- or high-risk patients; however, survival benefits of LND in clinically node-negative patients need further exploration.
Methods:
Patients with T2+N0M0 PSCC were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). Inclusion required histologically confirmed squamous cell carcinoma localized to the penis. Patients with unavailable staging or unknown followup were excluded. Chi-square tests, Kaplan-Meier survival curves, and multivariable Cox regression analyses assessed disease-specific survival (DSS).
Results:
A total of 825 patients were analyzed. The cohort predominantly included non-Hispanic White (65.2%) and Hispanic (22.3%) patients, with a median age of 69 years. Most patients were married (57.2%), while few received radiation (6.6%) or chemotherapy (3.5%). Only 23.5% underwent LND, with no significant variation across T stages. Median followup was 60 months. Chemotherapy usage increased significantly with advancing T stage (p=0.009), whereas radiation did not. LND significantly improved DSS overall (p<0.001) and specifically in T2 (p=0.040) and T3 stages (p=0.002). Multivariable analysis identified LND as an independent protective factor (hazard ratio [HR] 0.457, 95% confidence interval [CI] 0.328-0.711, p<0.001). Younger patients (<40 years) had higher LND rates (56%) compared to older patients (>70 years; 14.8%).
Conclusions:
Despite NCCN guidelines recommending LND for T2N0M0 PSCC, utilization remains low. Our findings highlight a survival advantage associated with regional LND, underscoring the need for enhanced urologist education to improve adherence and patient outcomes.
