title: Penile sparing surgery for penile cancer-does it affect survival?
abstract: OBJECTIVE
  Management of squamous cell carcinoma of the penis changed in recent decades in favor of penile sparing surgery. We assessed whether penile sparing therapies were increasingly applied in our penile squamous cell carcinoma cohort with time and whether penile sparing affected 5-year cancer specific survival.
  
  
  METHODS
  We reviewed the records of 1,000 patients treated between 1956 and 2012, of whom 859 with invasive tumors were eligible for analysis. Tumors were staged according to the 2009 TNM classification. Binary logistic regression was used to assess penile preservation vs amputation with time. Cancer specific survival was analyzed using the Kaplan-Meier method and multivariable Cox proportional hazards model. Competing risk analysis was done for local recurrence.
  
  
  RESULTS
  With time significantly fewer penile amputations were performed. The 5-year cumulative incidence of local recurrence as the first event after penile preservation was 27% (95% CI 23-32) while after (partial) penectomy it was 3.8% (95% CI 2.3-6.2, Gray test p <0.0001). Patients treated with penile preservation showed no significant difference in survival compared to patients treated with (partial) amputation after adjusting for relevant covariables. Factors associated with cancer specific survival were pathological T stage, pathological N stage and lymphovascular invasion on multivariable analysis. In the penile preservation group local recurrence as a time dependent variable in a Cox model was not associated with cancer specific survival (HR 0.52, 95% CI 0.21-1.24, p = 0.13).
  
  
  CONCLUSIONS
  Significantly more penile preservation therapies were performed in more recent years. Although patients treated with penile preservation experienced more local recurrences, 5-year cancer specific survival was not jeopardized.
authors.affiliation: Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands.
authors.forename: Rosa S
authors.initials: RS
authors.lastname: Djajadiningrat
authors.affiliation: Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: van Werkhoven
authors.affiliation: Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Meinhardt
authors.affiliation: Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands.
authors.forename: Bas W G
authors.initials: BW
authors.lastname: van Rhijn
authors.affiliation: Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands.
authors.forename: Axel
authors.initials: A
authors.lastname: Bex
authors.affiliation: Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands.
authors.forename: Henk G
authors.initials: HG
authors.lastname: van der Poel
authors.affiliation: Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands. Electronic address: s.horenblas@nki.nl.
authors.forename: Simon
authors.initials: S
authors.lastname: Horenblas
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D010412:Penile Neoplasms / Q000401:mortality* / Q000601:surgery*; D010413:Penis / Q000601:surgery*; D015996:Survival Rate; D013521:Urologic Surgical Procedures, Male / Q000379:methods
keywords: amputation; carcinoma; organ sparing treatments; penis; squamous cell; survival analysis