Hoogeveen, F.J.S. (Fokke) (2017) Outcomes of penile squamous cell carcinoma in the University Medical Center Groningen between 1995 and 2016. thesis, Medicine.
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Abstract
Penile carcinoma is a rare malignancy. Multiple forms of penile carcinoma exist; the most common form is squamous cell carcinoma (SCC). Penile SCC is a primarily local malignancy but has a T-stage depended risk to spread to the inguinal and pelvic lymph nodes. The classic gold standard of nodal staging has been inguinal lymph node dissection (ILND), however over the past decades in the Netherlands this has shifted towards dynamic sentinel node biopsy (DSNB). Due to the rarity of penile SCC relatively few studies exist on treatment outcomes such as morbidity and survival, especially in regards to the use of DSNB compared to ILND Goals The goals of this study were to evaluate the overall (OS) and cancer specific (CSS) 5-year survival rates of patients with penile SCC treated in the UMCG over the past 20 years. And to identify factors affecting survival and to evaluate the specificity and morbidity of the DSNB procedure compared to ILND. Methods A total of 127 men with penile SCC staged T1-4, N0-3 and M0-1 were included in our database, data were retrieved retrospectively from electronic patient files. Tumors were (re)staged according to the TNM-classification of 2009. Additional data (n=304) from the national cancer registry for the north of the Netherlands were obtained and compared to our database. Survival was calculated as an interval between the date of pathologically proven diagnosis and the last visit to the outpatient clinic or confirmed death. Complications were graded according to the Clavien-Dindo classification. Statistical analysis was performed with Statistical Package of Social Sciences (SPSS) version 22.0, a p-value < 0.05 was considered statistically significant. Results The 5-year OS and CSS in the UMCG group were 61% and 67.5% respectively. These did not differ significantly from the regional 5-year OS rate, p = 0.17. Survival of node positive patients differed significantly from node negative patients, 45% vs. 84% (HR 4.8, (95% CI 2.1-11.3). Extra nodal growth and two or more positive lymph nodes were associated with worse 5-year CSS, 13% (HR 2.97, 95% CI 1.37-15.75) & 26% (HR 4.64, 95% CI 1.01-8.68) respectively. The false-negative rate of the DSNB procedure in our population was 4,7%. Patients who underwent DSNB had a significantly lower complication rate than those who underwent ILND, p < 0.001. Conclusions The 5-year OS and CSS rates of patients with penile SCC treated in the UMCG over the past 20 years were 61% and 67,5% respectively. We showed that nodal status, extra nodal growth and number of positive nodes ³ 2 are associated with poor survival. The false negative rate of DSNB in our population matched the rate in current literature. DSNB was associated with lower incidence of complications than ILND. Therefore, DSNB should be used as the primary method of invasive staging in patients with penile carcinoma.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Leliveld-Kors, Dr. A.M. and oncological urologist and Department of urology University Medical Center Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1293 |
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