A contemporary population-based assessment of the rate of lymph node dissection for penile carcinoma.
BACKGROUND
The adherence rate to National Cancer Institute (NCI) recommendations regarding inguinal lymph nodes dissection (ILND) in high grade T1 (G3T1) and T2-4 squamous cell carcinoma of the penis (SCCP) is not known. We assessed ILND rates in a North American cohort.


METHODS
The 17 registries of the Surveillance, Epidemiology, and End Results (SEER) database included 868 patients with SCCP, diagnosed between 1988 and 2006. Analyses consisted of univariable and multivariable logistic regression models.


RESULTS
Overall, 27.6% of patients underwent an ILND. ILND rates were directly proportional with T stage: 19.0%, 30.5%, 30.6%, and 32.6% for, respectively, G3T1, T2, T3, and T4 SCCP (chi-square trend, P = 0.01). ILND rates also increased over time and were 19.3, 27.3, 30.7, and 30.8% for respectively, 1988-1995, 1996-2000, 2001-2003, and 2004-2006 periods (chi-square trend, P = 0.03). Finally, ILND rates decreased with patient age and were 42.6, 33.2, 24.7, and 7.3% for, respectively, patients aged ≤ 57, 58-68, 69-78 and ≥ 79 years of age (chi-square trend, P < 0.001). All 3 variables (T-stage, year of primary tumor excision and patient age) achieved independent predictor status in multivariable analyses.


CONCLUSIONS
The overall rate of ILND is low. Nonetheless, there is an upward trend over time. Our data indicate that the adherence to the NCI ILND guidelines is suboptimal. In consequence, ILNDs should be more strongly encouraged.
Thuret
Rodolphe
R
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada.
Sun
Maxine
M
Lughezzani
Giovanni
G
Budaus
Lars
L
Liberman
Daniel
D
Abdollah
Firas
F
Morgan
Monica
M
Johal
Rupinder
R
Jeldres
Claudio
C
Latour
Mathieu
M
Shariat
Shahrokh F
SF
Iborra
François
F
Guiter
Jacques
J
Patard
Jean-Jacques
JJ
Perrotte
Paul
P
Karakiewicz
Pierre I
PI
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D011159:Population Surveillance; D011379:Prognosis; D018426:SEER Program; D021701:Sentinel Lymph Node Biopsy / Q000592:standards*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D013521:Urologic Surgical Procedures, Male