Introduction:

Penile squamous cell carcinoma (pSCC) is rare in the United States. In 2020, the American Cancer Society estimates 2,200 new cases of pSCC and 440 deaths. Treatments for pSCC negatively impact patients’ quality of life and ILND in particular is highly morbid. Also, patients with advanced disease have a poor prognosis. Palliative care can improve physical, psychologic, social, and spiritual well-being; especially if instituted concurrent with curative-intent oncologic care early in the disease course. Palliative care has recently been shown to be underused in patients with advanced pSCC using the National Cancer Database. Our primary objective is to determine risk factors associated with survival of 6 months of less using a large multi-institutional international cohort of patients undergoing inguinal lymph node dissection (ILND), in order to identify patients most likely to benefit from early, concurrent palliative care.

Methods:

We identified all patients diagnosed with pSCC between 1980-2017 in a cohort of patients derived from eight high volume referral centers in seven countries. Patients who underwent ILND and had complete data were included in the analysis. Patients were categorized by duration of survival; ≤6 months or >6 months. Baseline patient and tumor characteristics were described. Recurrence and the site of recurrence were identified. Multivariable logistic regression analysis was used to determine associations with survival ≤6months. Exploratory analyses were performed for survival ≤12 and ≤24 months.

Results:

The cohort consisted of 707 patients with a median follow up of 22 months. In total, 57 (8.1%) and 124 (17.5%) patients survived ≤6 months and ≤12 months from the date of ILND, respectively. Patients who survived ≤6 months were older (64 versus 59 years), more likely to have lymphovascular invasion (36% versus 23%, p=0.046), and had more advanced pT and pN stage on univariable analysis. On multivariable analysis, survival ≤6 months was associated with age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.06, p=0.006) and pN2 disease (OR 2.96, 95% CI 1.18-8.13, p=0.025). A predictive model is shown in Figure 1 and yielded an area under the curve of 0.73. Survival ≤6 and ≤12 months was 13.2% and 25.1% for those with pT3/4 disease, and 9.7% and 25.3% for those with pN3 disease. Among patients who recured, more than half (52%) survived ≤6 months (Figure 2).

Conclusion:

In this cohort undergoing ILND for pSCC, about 1 in 12 patients will survive no longer than 6 months. Over 50% of patients with nodal or distant recurrence died within 6 months. An initial goal of this dataset was to determine how systemic therapy impacts outcomes for patients with pSCC and use these results to drive improvement in systemic therapies. While this population suffers from high morbidity and poor quality of life, we can surmise but not prove that palliative care could ameliorate these disparities; particularly for patients with advanced or recurrent disease. Our data supports the need for alternative strategies for managing patients with advanced or recurrent pSCC, one of which could include a greater emphasis on systemic cancer-directed care and concurrent palliative care. Additionally, these results may help identify triggers for providing patients with an additional layer of support with subspecialty palliative care consultation. This warrants further exploration.

Funding: N/A