Abstract
OBJECTIVES: Penile squamous cell carcinoma (PSCC) is the most common penile cancer, accounting for ≥ 95% of cases, though it accounts for < 1% of all malignancies in men in the United States. We report an updated, stage-stratified analysis of the efficacy of surgery, radiation, and chemotherapy, including adjuvant and neoadjuvant chemoradiation, with further analysis of demographic and clinical factors. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database, patients with PSCC diagnosed between 2000 and 2018 were identified. Five-year overall survival Cox regression analysis as well as univariate Kaplan-Meier analysis were performed, stratified by demographic and treatment variables. RESULTS: Two thousand seven hundred eight patients with PSCC were identified, with 57.8% being older than 65 years at diagnosis and 94.2% undergoing surgical intervention. With multivariate analysis, increasing disease stage (p < 0.001), age < 65 years (p < 0.001), lower disease grade (p < 0.001) were all associated with increased survival, while treatment with chemotherapy or radiotherapy was both associated with decreased survival (p = 0.002 and < 0.001, respectively). On univariate analysis, less invasive surgery was associated with increased survival among patients with low-grade, local (p < 0.001) or regional (p = 0.03) disease. Among those with high-grade disease, local excision was associated with increased survival (p = 0.008), though among those with regional disease no survival difference was seen (p = 0.86). Patients with regional disease saw increasing survival with four or more lymph nodes dissected (69% vs. 61%, respectively; p = 0.002). CONCLUSIONS: Surgical management of penile SCC remains the mainstay treatment, and less invasive surgery is associated with noninferior or improved 5-year overall survival regardless of disease stage and grade. Patients with regional disease had increased survival when four or more lymph nodes were dissected. Future analysis of these trends stratified by disease subhistology and more granular analysis of the role of lymphadenectomy are warranted.