Total margin control is superior to traditional margin assessment for treatment of low-stage penile squamous cell carcinoma Journal Article
| Authors: | O'Connell, K. A.; Thomas, J. L.; Murad, F.; Zhou, G.; Sonpavde, G. P.; Mossanen, M.; Clinton, T. N.; Ji-Xu, A.; Alton, K.; Spiess, P. E.; Rossi, A. M.; Schmults, C. D. |
| Article Title: | Total margin control is superior to traditional margin assessment for treatment of low-stage penile squamous cell carcinoma |
| Abstract: | Purpose: Penile cancer is rare, with significant morbidity and limited literature assessing utility of peripheral and deep en face margin assessment (PDEMA) vs traditional margin assessment (vertical sections) on treatment outcomes. Materials and Methods: This was a 32-year retrospective multicenter cohort study at 3 academic tertiary care centers. The cohort consisted of 189 patients with histologic diagnosis of in situ or T1a cutaneous squamous cell carcinoma ofthe penis at Brigham and Women's, Massachusetts General Hospital (1988-2020), and Memorial Sloan Kettering Cancer Center (1995-2020) treated with PDEMA surgical excision, excision/circumcision, or penectomy/glansectomy. Local recurrence, metastasis, and disease-specific death were assessed via multivariable Cox proportional hazard models. Results: The cohort consisted of 189 patients. Median age at diagnosis was 62 years. Median tumor diameter was 1.3 cm. The following outcomes of interest occurred: 30 local recurrences, 13 metastases, and 5 diseasespecific deaths. Primary tumors were excised with PDEMA (N [ 30), excision/circumcision (N [ 110), or penectomy/glansectomy (N [ 49). Of patients treated with traditional margin assessment (non-PDEMA), 12% had narrow or positive margins. Five-year proportions were as follows with respect to local recurrence-free survival, metastasis-free survival, and disease-specific survival/progression-free survival, respectively: 100%, 100%, and 100% following PDEMA; 82%, 96%, and 99% following excision/circumcision; 83%, 91%, and 95% following penectomy/glansectomy. A limitation is that this multi-institutional cohort study was not externally validated. Conclusions: Initial results are encouraging that PDEMA surgical management effectively controls earlystage penile squamous cell carcinoma the penis at Brigham and Women's, Massachusetts General Hospital (1988-2020), and Memorial Sloan Kettering Cancer Center (1995-2020) treated with PDEMA surgical excision, excision/circumcision, or penectomy/glansectomy. Local recurrence, metastasis, and disease-specific death were assessed via multivariable Cox proportional hazard models. Results: The cohort consisted of 189 patients. Median age at diagnosis was 62 years. Median tumor diameter was 1.3 cm. The following outcomes of interest occurred: 30 local recurrences, 13 metastases, and 5 diseasespecific deaths. Primary tumors were excised with PDEMA (N [ 30), excision/circumcision (N [ 110), or penectomy/glansectomy (N [ 49). Of patients treated with traditional margin assessment (non-PDEMA), 12% had narrow or positive margins. Five-year proportions were as follows with respect to local recurrence-free survival, metastasis-free survival, and disease-specific survival/progression-free survival, respectively: 100%, 100%, and 100% following PDEMA; 82%, 96%, and 99% following excision/circumcision; 83%, 91%, and 95% following penectomy/glansectomy. A limitation is that this multi-institutional cohort study was not externally validated. © 2024 Lippincott Williams and Wilkins. All rights reserved. |
| Keywords: | middle aged; retrospective studies; clinical trial; squamous cell carcinoma; carcinoma, squamous cell; cohort studies; neoplasm recurrence, local; skin neoplasms; cohort analysis; pathology; retrospective study; skin tumor; conservative treatment; multicenter study; tumor recurrence; penile neoplasms; mohs surgery; penis tumor; procedures; organ sparing treatments; humans; human; male; female; penile neoplasms/ pathology; penile neoplasms/surgery; penis/surgery |
| Journal Title: | Journal of Urology |
| Volume: | 211 |
| Issue: | 1 |
| ISSN: | 0022-5347 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2024-01-01 |
| Start Page: | 90 |
| End Page: | 100 |
| Language: | English |
| DOI: | 10.1097/ju.0000000000003736 |
| PUBMED: | 37788015 |
| PROVIDER: | scopus |
| PMCID: | PMC10841097 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Source: Scopus |
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