Key points are not available for this paper at this time.
OBJECTIVES: To assess local recurrence (LR) and its impact on cancer-specific survival (CSS) in an international multicentric homogeneous cohort of lower-risk patients with penile squamous cell carcinoma (PSCC) that underwent glans-sparing surgery (GSS). PATIENTS AND METHODS: We retrospectively studied patients with PSCC treated with circumcision, wide local excision, glans resurfacing, partial glansectomy and laser ablation, collectively defined as GSS. To understand whether LR itself impacts CSS, patients with lymphatic or systemic disease prior or concurrent with LR were excluded. Predictors of LR and its impact on CSS were assessed using Cox proportional hazard regression and Kaplan-Meier survival analysis, respectively. RESULTS: Across 15 institutions, 550 patients were included. The majority had pathological T1 stage (79%) tumours, reflecting the selection of less invasive tumours for GSS. At a median (interquartile range) follow-up of 41 (23-63) months, 162 (29%) patients experienced LR. LR did not affect cancer-specific mortality and 5-year CSS remained at 99%. Three patients died from penile cancer, none of whom showed a LR during their disease course. The presence of penile intraepithelial neoplasia in the surgical margin was an independent predictor of LR (hazard ratio 2.28, P = 0.02), even after adjusting for additional treatments. CONCLUSION: Patients undergoing GSS for PSCC demonstrate excellent survival outcomes, despite LR in 29% of men. These findings support the use of GSS as a safe and effective treatment option for patients committed to adequate follow-up.
Elst et al. (Mon,) studied this question.