Introduction:

Penile cancer, though rare, is a malignancy with significant impact on patients' health and quality of life. Understanding the epidemiology and clinical outcomes of penile cancer is crucial for developing effective treatment and management strategies. However, limited data exist on the demographic distribution, hospital characteristics, and clinical outcomes of penile cancer patients in the United States. This study aims to fill this gap by providing a comprehensive analysis using the National Inpatient Sample (NIS) database, focusing on identifying disparities in outcomes and healthcare costs among different racial and demographic groups.

Methods:

We conducted a retrospective cohort study using the NIS database. Penile cancer cases were identified using the ICD-10 code C60. A total of 446 cases were included in the analysis. We used survey-weighted descriptive statistics and regression models to analyze demographic variables, hospital characteristics, length of stay (LOS), hospitalization costs, and mortality rates. Adjusted odds ratios (OR) for mortality and adjusted coefficients for LOS and hospitalization costs were calculated using logistic and linear regression models, respectively.

Results:

The analysis included 446 penile cancer cases with a mean age of 64.7 years. The racial distribution was predominantly White (62.8%), followed by Black (11.7%), Hispanic (19.4%), Asian/Pacific Islander (3.2%), Native American (0.2%), and Other (2.7%). Most admissions occurred in teaching hospitals (83.6%) and large bed-sized hospitals (58.9%), with regional distribution as follows: Northeast (19.5%), Midwest (19.7%), South (39.9%), and West (20.9%).

The overall in-hospital mortality rate was 4.3% (95% CI: 2.7%-6.6%). Higher odds of mortality were observed in Hispanic (OR 3.30, 95% CI: 1.01-10.73, p=0.047) and Other racial groups (OR 15.94, 95% CI: 2.37-106.95, p=0.004). The mean length of stay (LOS) was 5.87 days (95% CI: 5.17-6.58). Longer LOS was associated with a higher Charlson comorbidity index (β = 0.48, 95% CI: 0.17-0.78, p=0.002).

The mean total hospitalization cost was $75,956.82 (95% CI: $64,366.83-$87,546.81). Increased costs were linked to a higher Charlson comorbidity index (β = 5626.24, 95% CI: 1177.99-10074.48, p=0.013), and Hispanic patients (β = 45,183.02, 95% CI: 14,628.59-75,737.44, p=0.004). 

Conclusion:

 This study reveals significant disparities in the clinical outcomes and hospitalization costs of penile cancer patients in the United States. The findings indicate that Hispanic and Other racial groups face higher mortality risks, while hospitalization costs are notably higher for Hispanic patients. The mean length of hospital stay is influenced by comorbidities and racial background, highlighting the complex interplay of factors affecting patient outcomes. These disparities underscore the urgent need for targeted interventions and healthcare policies to address the unique challenges faced by these patient populations, aiming to improve clinical outcomes and reduce healthcare costs associated with penile cancer. Further research is essential to understand the underlying causes of these disparities and develop effective strategies for equitable care.

Funding: N/A