Introduction:

Penile squamous cell carcinoma (SCC) represents up to 10% of male cancers in developing countries, with poor survival if untreated. We reported an updated efficacy of surgery on 5-year survival. Previous studies demonstrate worse survival for patients with lymph node (LN) positive penile SCC. However, no studies track survival based on LN removal or LN examination frequency. As LN metastases are a major prognostic factor for penile SCC, we compared 5-year survival in patients with various numbers of LNs examined and removed. Additionally, we recognize that penile SCC grading remains challenging due to lack of consensus surrounding anaplastic cells proportion required for grading, limiting prediction of metastases and survival. Thus, we compared clinical and pathologic grading of penile SCCs in the past 5 years. Lastly, it was reported in 2013 that penile SCC survival was higher in married men. Therefore, we provide an updated 5-year survival based on marital status.

Methods:

We queried the following patient cohorts among 5,219 penile SCC patients in the SEER database: 525 patients with no surgery, 4,606 patients with site-specific tumor resection; 4,314 patients with documented numbers of regional LNs removed; 5,052 patients with documented numbers of regional LNs examined; 329 patients with clinically and pathologically graded penile SCCs; 2,378 unmarried patients at diagnosis, and 2,841 married patients at diagnosis.

Results:

Penile SCC patients with site-specific tumor resection had roughly 20% greater 5-year survival than those without surgery (p < 0.05). There was no significant difference in 5-year survival between penile SCC patients with varying numbers of LNs removed. Patients with 1-3 LNs examined had greater 5-year survival outcomes than those without LNs examined. Regarding clinical grade, 62% of cases were unknown, 15.5% of cases were grade I, 15.5% of cases were grade II, and 7% of cases were grade III. Regarding pathological grade, 38% were grade II, 27% were unknown, 21% were grade I, and 14% were grade III. Finally, patients married at diagnosis had significantly greater 5-year survival than patients unmarried at diagnosis (p < 0.05).

Conclusion:

Our study reaffirms the value of site-specific tumor resection in promoting penile SCC survival. By contrast, LN removal did not appear to influence penile SCC survival, though examination of an intermediate number of LNs likely remains valuable for confirmatory diagnosis. We observed poor alignment between clinical and pathological grading of penile SCCs, with pathological grading providing greater certainty, especially for moderate grade tumors. Marriage at diagnosis remains protective for penile SCC.

Funding: N/A