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Adjuvant Chemotherapy in the Treatment of Lymph Node Positive Squamous Cell Carcinoma of the Penis: Analysis of the National Cancer Database
Valary T. Raup, MD, Nawar Hanna, MD, Manuel Ozambela, MD, Jairam Eswara, MD.
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

BACKGROUND: While the use of neoadjuvant TIP (paclitaxel, ifosfamide, and cisplatinin) has been well described, the use of adjuvant chemotherapy (ACT) in the treatment of node positive squamous cell carcinoma (SCC) of the penis is controversial and there has been few large studies looking at utilization and outcomes. We sought to describe the use of adjuvant chemotherapy in patients with lymph node positive disease (N+) penile cancer using a large nationwide U.S. cancer database.METHODS: The National Cancer Data Base (NCDB) (2004-2014) was used to extract all patient with non-metastatic SCC of the penis who underwent partial or total/radical penectomy with inguinal lymph node dissection. Only patients found to have N+ were included in our cohort. Patients were categorized according to receipt of ACT. Descriptive statistics were used to compare patients according to receipt of ACT. Multivariable logistic regressions were performed to determine patient, tumor or facility characteristics associated with use of ACT. Finally, multivariable Cox regression analysis was used to determine the impact of ACT on overall survival (OS).
RESULTS: A total of 661 patients with N+M0 penile SCC were identified. Of these, 253 (38.3%) patients underwent ACT. Median age at diagnosis was 59 in those who received ACT and 65 in those who did not (p<0.001). After adjusting for all variables, ACT was more likely to be administered to patients with a lower Charlson-Deyo Score (p=0.04), lower education level (p=0.02), patients treated at a community cancer center (p=0.03) or in the New England/Mid-Atlantic regions (p<0.001), and patients with higher clinical or pathologic N stage (p<0.001; p<0.001). Median survival was 23.5 months for patients who received ACT and 24.3 months for those who did not, which approached significance statistically (p=0.05). After adjusting for all available covariates, there was no statistically significant difference in median survival (p=0.224, HR 1.16, 95% CI 0.91).CONCLUSIONS: More the a third of patients with N+ SCC of the penis receive ACT. Other than more advanced disease, many patient and facility characteristics are associated with receipt of ACT. We did not find significant differences in overall survival according to receipt of ACT. Further studies are needed to better define the role of ACT in advanced SCC of the penis.

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