Risk factors and negative consequences of patient's delay for penile carcinoma.
BACKGROUND
Delayed first medical consultation (patient's delay) is quite common in cases of penile carcinoma (PC), but its reasons and impacts remain unclear. We conducted this study to ascertain risk factors resulting in delayed treatment seeking and evaluate its influence on prognosis.


METHODS
From 2004 to 2010 at 4 centers, 254 patients were enrolled into this study from 262 consecutive PC cases. Patients' sexual performance was investigated using the International Index of Erectile Function (IIEF)-15 at the sixth-month end after treatment. Data for prognostic analyses was obtained via a 5-year follow-up.


RESULTS
A multivariate model ascertained 4 risk factors (single, living in rural areas, heavy drinking alcohol, and aspecific initial symptoms) and 1 protective factor (history of condyloma) significantly associated with patient's delay. Delay >3 months led to significant risks for adverse clinical characteristics, low penis-sparing rate, and poor sexual function restoration. Although patient's delay was not found to impact on postoperative relapses and 5-year overall survival (OS), patients with delay >6 months had significantly inferior 2-year OS.


CONCLUSIONS
Single, living in rural areas, heavy drinking alcohol, and aspecific initial symptoms are significant risk factors of PC associated with patient's delay. Delay >3 months will lead to significantly inferior clinical consequences. Minimizing patient's delay is the key to avoid amputation and retain superior sexual potency. Improving patient education on initial symptoms of PC is necessary in men of >40 years old.
Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Wen
W
Gao
College of Basic Medical Sciences, Nanjing Medical University, Nanjing, Jiangsu, China.
Le-bin
LB
Song
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
Jie
J
Yang
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
Ning-hong
NH
Song
Institute of Dermatology Surgery, China Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China.
Xin-feng
XF
Wu
Department of Dermatology, Shanghai Skin Diseases Hospital, Shanghai, China.
Ning-jing
NJ
Song
Department of Urology, Jiangsu Province Official Hospital, Nanjing, Jiangsu, China.
Di
D
Qiao
State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China.
Chen
C
Chen
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
Jia-yi
JY
Zhang
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China. yj0614@sina.com.
Zeng-jun
ZJ
Wang
D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D000328:Adult; D000368:Aged; D057210:Delayed Diagnosis / Q000523:psychology*; D004485:Eczema / Q000175:diagnosis / Q000209:etiology*; D004890:Erythema / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D011379:Prognosis; D012017:Referral and Consultation; D012307:Risk Factors; D013997:Time Factors
Male sexual function; Overall survival; Patient’s delay; Penile carcinoma; Relapse; Risk factors