1
|
Tan X, Cai T, Wang Y, Wu Z, Zhou Q, Guo S, Li J, Yuan G, Liu Z, Li Z, Liu Z, Tang Y, Zou Y, Luo S, Qin Z, Zhou F, Lin C, Han H, Yao K. Regional lymph node mapping in patients with penile cancer undergoing radical inguinal lymph node dissection - a retrospective cohort study. Int J Surg 2024; 110:2865-2873. [PMID: 38329065 DOI: 10.1097/js9.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Radical inguinal lymph node dissection (rILND) is the most available treatment to cure penile cancer (PC) with limited inguinal-confined disease. However, guidelines regarding acceptable boundaries of rILND are controversial, and consensus is lacking. The authors aimed to standardize the surgical boundaries of rILND with definite pathological evidence and explore the distribution pattern of inguinal lymph nodes (ILNs) in PC. METHODS A total of 414 PC patients from two centers who underwent rILND were enrolled. The ILN distribution was divided into seven zones anatomically for pathological examination. Student's t test and Kaplan-Meier survival analysis were used. RESULTS ILNs displayed a funnel-shaped distribution with high density in superior regions. ILNs and metastatic nodes are present anywhere within the radical boundaries. Positive ILNs were mainly concentrated in zone I (51.7%) and zone II (41.3%), but there were 8.7% and 12.3% in inferior zones V and VI, respectively, and 7.1% in the deep ILNs. More importantly, a single positive ILN and first-station positive zone was detected in all seven regions. Single positive ILNs were located in zones I through VI in 40.4%, 23.6%, 6.7%, 18.0%, 4.5%, and 1.1%, respectively, and 5.6% presented deep ILN metastasis directly. CONCLUSIONS The authors established a detailed ILN distribution map and displayed lymphatic drainage patterns with definite pathological evidence using a large cohort of PC patients. Single positive ILNs and first-station metastatic zones were observed in any region, even directly with deep ILN metastasis. Only rILND can ensure tumor-free resection without the omission of positive nodes.
Collapse
Affiliation(s)
- Xingliang Tan
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Taonong Cai
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Yanjun Wang
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Zhiming Wu
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Qianghua Zhou
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Shengjie Guo
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Jing Li
- Department of Urology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou
| | - Gangjun Yuan
- Department of Urology Oncological Surgery, Chongqing University Cancer Hospital
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing
| | - Zhenhua Liu
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Zhiyong Li
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Zhicheng Liu
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Yi Tang
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Yuantao Zou
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Sihao Luo
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Zike Qin
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Fangjian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Chunhua Lin
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, People's Republic of China
| | - Hui Han
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| | - Kai Yao
- Department of Urology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in Southern China
- Collaborative Innovation Center of Cancer Medicine
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer
| |
Collapse
|
2
|
Gravas S, Malde S, Cornu JN, Gacci M, Gratzke C, Herrmann TRW, Karavitakis M, Mamoulakis C, Rieken M, Sakalis VI, Schouten N, Smith EJ, Speakman MJ, Tikkinen KAO, Alivizatos G, Bach T, Bachmann A, Descazeaud A, Desgrandchamps F, Drake M, Emberton M, Kyriazis I, Madersbacher S, Michel MC, N'Dow J, Perachino M, Plass K, Rioja Sanz C, Umbach R, de Wildt M, Oelke M, de la Rosette JJMCH. From BPH to male LUTS: a 20-year journey of the EAU guidelines. Prostate Cancer Prostatic Dis 2024; 27:48-53. [PMID: 37488274 DOI: 10.1038/s41391-023-00700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/07/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus.
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen-Hôpital Charles Nicolle, Rouen, France
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | | | - Thorsten Bach
- Department of Urology, Asklepios Westklinikum Hamburg, Hamburg, Germany
| | | | | | | | - Marcus Drake
- Bristol Urological Institute, University of Bristol, Bristol, UK
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, and University College London Hospitals NHS Foundation Trust, London, UK
| | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | | | - Martin C Michel
- Department of Pharmacology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - James N'Dow
- NHS Grampian, Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Massimo Perachino
- Center for Miniinvasive Techniques in Urology, Clinica S. Rita, Vercelli, Italy
| | - Karin Plass
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Roland Umbach
- Department of Urology, Klinikum Sindelfingen-Bӧblingen, Sindelfingen, Germany
| | | | - Matthias Oelke
- Department of Urology, St. Antonius-Hospital, Gronau, Germany
| | | |
Collapse
|
3
|
Pecoraro A, Elst L, Roussel E, Miletić M, Vanthoor J, De Ridder D, Van Rompuy AS, De Cuyper E, Dumez H, De Meerleer G, de Wever L, Goffin K, Van Poppel H, Joniau S, Albersen M. Impact of the Standardization of Penile Cancer Care on the Quality of Care, Outcomes, and Academic-driven Centralization in a Single eUROGEN Referral Center. Eur Urol Focus 2024; 10:57-65. [PMID: 37537111 DOI: 10.1016/j.euf.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/17/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Penile cancer (PeCa) represents a diagnostic and therapeutic challenge given the low patient volume, which may result in inadequate physician expertise and poor guideline adherence. Since 2015, we have developed a specific care pathway for PeCa in our tertiary referral center. OBJECTIVE To evaluate the impact of a dedicated PeCa care pathway on patient management, the adequacy of pathological reporting, and oncological outcomes. DESIGN, SETTING, AND PARTICIPANTS We retrospectively queried our institutional registry (S-66482) to identify patients who were surgically treated for PeCa between January 1989 and April 2022. The patient numbers were evaluated within a broader national context. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We compared patient, surgery, tumor, and pathological data before and after 2015. Kaplan-Meier analysis was used to compare local and regional recurrence rates and cancer-specific survival (CSS). RESULTS AND LIMITATIONS Overall, 313 patients were included, of whom 204 (65.1%) were surgically treated after 2015. The median number of patients treated yearly was significantly higher after 2015 (26 vs 5; p < 0.01). Patients treated after 2015 more frequently had no palpable lymph nodes at diagnosis, despite similar primary tumor stage. After adoption of the PeCa care pathway, organ-sparing surgery (OSS) was more commonly performed (79.9% vs 57.8%; p < 0.01) despite local staging being similar and without observing a significant increase in positive margins. Surgical staging in patients with European Association of Urology intermediate- or high-risk tumors was conducted more frequently after 2015 (90% vs 41%; p < 0.01). Pathology reporting was standardized, and there was more frequent reporting of p16 staining status (81.4% vs 8.3%; p < 0.01), lymphovascular invasion (93.8% vs 44.3%; p < 0.01), and perineural invasion (92.4% vs 44.3%; p < 0.01) following implementation. CONCLUSIONS Implementation of a standardized care pathway for PeCa resulted in higher rates of OSS and pathological nodal staging and more complete pathology reports. Considering that these changes were associated with an increase in the number of patients treated, academic-driven centralization may play a role in optimizing the management of these patients. PATIENT SUMMARY We evaluated the impact of a care pathway for patients with penile cancer on patient management, the completeness of pathology reporting, and cancer control. We found that implementation of this pathway was associated with an increase in the number of patients treated, higher rates of organ-sparing surgery and lymph node staging, and more complete pathology reports. Centralization of care may play a role in optimizing the management of penile cancer.
Collapse
Affiliation(s)
- Alessio Pecoraro
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Laura Elst
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Marija Miletić
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Clinical Department of Oncology and Nuclear Medicine, Sisters of Mercy University Hospital Center, Zagreb, Croatia
| | - Joren Vanthoor
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium; Department of Quality Improvement, University Hospitals Leuven, Leuven, Belgium
| | | | - Eline De Cuyper
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Herlinde Dumez
- Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth de Wever
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Karolien Goffin
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.
| |
Collapse
|
4
|
Scornajenghi CM, Asero V, Bologna E, Basile G, De Angelis M, Moschini M, Del Giudice F. Organ-sparing treatment for T1 and T2 penile cancer: an updated literature review. Curr Opin Urol 2023; Publish Ahead of Print:00042307-990000000-00098. [PMID: 37377374 DOI: 10.1097/mou.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE OF REVIEW Penile cancer (PeCa) is an orphan disease due to its rare incidence in high-income countries. Traditional surgical options for clinical T1-2 disease, including partial and total penectomy, can dramatically affect patient's quality of life and mental health status. In selected patients, organ-sparing surgery (OSS) has the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of various OSSs currently available for men diagnosed with PeCa seeking an organ-preserving option. RECENT FINDINGS Patient survival largely depends on spotting and treating lymph node metastasis at an early stage. The required surgical and radiotherapy skill sets cannot be expected to be available in all centers. Consequently, patients should be referred to high-volume centers to receive the best available treatments for PeCa. SUMMARY OSS should be used for small and localized PeCa (T1-T2) as an alternative to partial penectomy to preserve patient's quality of life while maintaining sexual and urinary function and penile aesthetics. Overall, there are different techniques that can be used with different response and recurrence rates. In case of tumor recurrence, partial penectomy or radical penectomy is feasible, without impacting overall survival.
Collapse
Affiliation(s)
- Carlo Maria Scornajenghi
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Vincenzo Asero
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Eugenio Bologna
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario De Angelis
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
5
|
Bada M, Crocetto F, Nyirady P, Pagliarulo V, Rapisarda S, Aliberti A, Boccasile S, Ferro M, Barone B, Celia A. Inguinal lymphadenectomy in penile cancer patients: a comparison between open and video endoscopic approach in a multicenter setting. J Basic Clin Physiol Pharmacol 2023; 34:383-389. [PMID: 36933235 DOI: 10.1515/jbcpp-2023-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/25/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES To compare differences of operative outcomes, post-operative complications and survival outcomes between open and laparoscopic cases in a multicenter study. METHODS This was a retrospective cohort study performed at three European centers from September 2011 to January 2019. The surgeon decision to perform open inguinal lymphadenectomy (OIL) or video endoscopic inguinal lymphadenectomy (VEIL) was done in each hospital after patient counselling. Inclusion criteria regarded a minimum follow-up of 9 months since the inguinal lymphadenectomy. RESULTS A total of 55 patients with proven squamous cell penile cancer underwent inguinal lymphadenectomy. 26 of them underwent OIL, while 29 patients underwent VEIL. For the OIL and VEIL groups, the mean operative time was 2.5 vs. 3.4 h (p=0.129), respectively. Hospital stays were lower in the VEIL group with 4 vs. 8 days in OIL patients (p=0.053) while number of days requiring drains to remain in situ was 3 vs. 6 days (p=0.024). The VEIL group reported a lower incidence of major complications compared to the OIL group (2 vs. 17%, p=0.0067) while minor complications were comparable in both groups. In a median follow-up period of 60 months, the overall survival was 65.5 and 84.6% in OIL and VEIL groups, respectively (p=0.105). CONCLUSIONS VEIL is comparable to OIL regarding safety, overall survival and post-operative outcomes.
Collapse
Affiliation(s)
- Maida Bada
- Department of Urology, San Bassanino Hospital, Bassano del Grappa, Vicenza, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology - Federico II University of Naples, Naples, Italy
| | - Peter Nyirady
- Department of Urology, Semmelweis University, Budapest, Budapest, Italy
| | - Vincenzo Pagliarulo
- Department of Urology, Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Sebastiano Rapisarda
- Department of Urology, Pederzoli Hospital Private Clinic SpA, Peschiera del Garda, Veneto, Italy
| | - Antonio Aliberti
- Urology, ASL 3 Napoli Castellammare di Stabia, Castellammare di Stabia, Italy
| | - Stefano Boccasile
- Department of Urology, Cima Barcelona Hospital, Barcelona, Catalogna, Spain
| | - Matteo Ferro
- Istituto Europeo di Oncologia, Milano, Lombardia, Italy
| | - Biagio Barone
- Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Campania, Italy
| | - Antonio Celia
- Department of Urology, San Bassanino Hospital, Bassano del Grappa, Veneto, Italy
| |
Collapse
|
6
|
Brassetti A, Anceschi U, Cozzi G, Chavarriaga J, Gavrilov P, Gaya Sopena JM, Bove AM, Prata F, Ferriero M, Mastroianni R, Misuraca L, Tuderti G, Torregiani G, Covotta M, Camacho D, Musi G, Varela R, Breda A, De Cobelli O, Simone G. Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement. Curr Oncol 2023; 30:1882-1892. [PMID: 36826107 PMCID: PMC9954864 DOI: 10.3390/curroncol30020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. METHODS A purpose-built multicenter, multi-national database was queried for stage I-IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan-Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. RESULTS A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score ≥ 3: 0% vs. 24%; p < 0.001). Although indicated, ILND was omitted in 8 cases (5%), while in 16, a modified template was properly used. Although median LNs yield was 17 (IQR: 11-27), 35% of the patients had <7 nodes retrieved from the groin. At Kaplan-Maier analysis, the Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94-0.99; p = 0.04). CONCLUSIONS Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality.
Collapse
Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-0652666772
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Cozzi
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Julian Chavarriaga
- Division of Urology, Clinica Imbanaco, Quiron Salud, Cali 760042, Colombia
- Division of Urology, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | - Pavel Gavrilov
- Department of Urology, Fondacio Puigvert, 08025 Barcelona, Spain
| | | | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Francesco Prata
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | | | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Giulia Torregiani
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Marco Covotta
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Diego Camacho
- Division of Urologic Oncology Instituto Nacional de Cancerologia, Bogota 111511, Colombia
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Rodolfo Varela
- Division of Urologic Oncology Instituto Nacional de Cancerologia, Bogota 111511, Colombia
| | - Alberto Breda
- Department of Urology, Fondacio Puigvert, 08025 Barcelona, Spain
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| |
Collapse
|
7
|
Voigt W, Trautwein M. Improved guideline adherence in oncology through clinical decision-support systems: still hindered by current health IT infrastructures? Curr Opin Oncol 2023; 35:68-77. [PMID: 36367223 DOI: 10.1097/cco.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE OF REVIEW Despite several efforts to enhance guideline adherence in cancer management, the rate of adherence remains often dissatisfactory in clinical routine. Clinical decision-support systems (CDSS) have been developed to support the management of cancer patients by providing evidence-based recommendations. In this review, we focus on both current evidence supporting the beneficial effects of CDSS on guideline adherence as well as technical and structural requirements for CDSS implementation in clinical routine. RECENT FINDINGS Some studies have demonstrated a significant improvement of guideline adherence by CDSSs in oncologic diseases such as breast cancer, colon cancer, cervical cancer, prostate cancer, and hepatocellular carcinoma as well as in the management of cancer pain. However, most of these studies were rather small and designs rather simple. One reason for this limited evidence might be that CDSSs are only occasionally implemented in clinical routine. The main limitations for a broader implementation might lie in the currently existing clinical data infrastructures that do not sufficiently allow CDSS interoperability as well as in some CDSS tools themselves, if handling is hampered by poor usability. SUMMARY In principle, CDSSs improve guideline adherence in clinical cancer management. However, there are some technical und structural obstacles to overcome to fully implement CDSSs in clinical routine.
Collapse
Affiliation(s)
- Wieland Voigt
- Wieland Voigt, Medical Innovations and Management, Steinbeis University Berlin, Berlin
| | - Martin Trautwein
- Martin Trautwein, Senior Medical Advisor, Cognostics GmbH, Munich, Germany
| |
Collapse
|
8
|
Diagnostic Accuracy of MRI in Local Staging (T Category) of Penile Cancer and the Value of Artificial Erection: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2022; 219:28-36. [PMID: 35195435 DOI: 10.2214/ajr.21.27063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Treatment recommendations of penile cancers are determined primarily by the local extent of the primary tumor. Clinical palpation is used for local staging. OBJECTIVE. We reviewed diagnostic performance of MRI in local staging of penile cancer in three clinical scenarios (questions [Qs] 1 through 3, Q1-Q3) and one imaging scenario (Q4). Q1 asked whether MRI reliably distinguishes ≤ T1 from ≥ T2 disease. Q2 asked whether clinical staging reliably identifies ≤ T1 versus ≥ T2 disease and how clinical staging compares to MRI. Q3 asked if MRI is accurate for diagnosis of T3 disease. Q4 asked if artificial erection (by intracavernosal injection of prostaglandin E1) improved accuracy of MRI in T categorization. EVIDENCE ACQUISITION. MEDLINE, EMBASE, and Cochrane Library databases were searched through September 13, 2021, for studies evaluating local staging of penile cancer using MRI with surgical pathology as the reference standard. Diagnostic accuracy was calculated using a bivariate random-effects model and hierarchic summary ROC mode Meta-regression was performed to test for covariate effects of MRI and artificial erection in Q3 and Q4, respectively. EVIDENCE SYNTHESIS. Eight studies and 481 patients were included. The sensitivity and specificity of MRI for Q1 were 86% (95% CI, 73-94%) and 89% (95% CI, 77-95%), respectively. AUC for MRI (0.94; 95% CI, 0.92-0.96) did not differ from clinical staging (0.87; 95% CI, 0.84-0.90; p = .83). For Q3, MRI had sensitivity and specificity of 80% (95% CI, 70-87%) and 96% (95% CI, 85-99%), respectively. For Q4, sensitivity and specificity for MRI with versus without artificial erection were 85% (95% CI, 71-92%) and 93% (95% CI, 77-98%) versus 86% (95% CI, 68-95%) and 84% (95% CI, 70-93%), respectively (p = .50). CONCLUSION. MRI staging of penile cancer may be considered for ≤ T1 versus ≥ T2 disease but did not appear more accurate than clinical staging. High specificity of MRI for diagnosis of ≥ T3 disease suggests that MRI may be useful when organ-sparing approaches are planned. MRI with and without artificial erection showed similar accuracy in local staging. CLINICAL IMPACT. MRI, with or without artificial erection, may be valuable in routine preoperative evaluation of local staging of penile cancer, particularly when organ-sparing options are considered.
Collapse
|
9
|
Lebentrau S, Wakileh GA, Schostak M, Schmid HP, Suarez-Ibarrola R, Merseburger AS, Hutterer GC, Necknig UH, Rink M, Bögemann M, Kluth LA, Pycha A, Burger M, Brookman-May SD, Bründl J, May M. Does the Identification of a Minimum Number of Cases Correlate With Better Adherence to International Guidelines Regarding the Treatment of Penile Cancer? Survey Results of the European PROspective Penile Cancer Study (E-PROPS). Front Oncol 2021; 11:759362. [PMID: 34912711 PMCID: PMC8667688 DOI: 10.3389/fonc.2021.759362] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background Penile cancer represents a rare malignant disease, whereby a small caseload is associated with the risk of inadequate treatment expertise. Thus, we hypothesized that strict guideline adherence might be considered a potential surrogate for treatment quality. This study investigated the influence of the annual hospital caseload on guideline adherence regarding treatment recommendations for penile cancer. Methods In a 2018 survey study, 681 urologists from 45 hospitals in four European countries were queried about six hypothetical case scenarios (CS): local treatment of the primary tumor pTis (CS1) and pT1b (CS2); lymph node surgery inguinal (CS3) and pelvic (CS4); and chemotherapy neoadjuvant (CS5) and adjuvant (CS6). Only the responses from 206 head and senior physicians, as decision makers, were evaluated. The answers were assessed based on the applicable European Association of Urology (EAU) guidelines regarding their correctness. The real hospital caseload was analyzed based on multivariate logistic regression models regarding its effect on guideline adherence. Results The median annual hospital caseload was 6 (interquartile range (IQR) 3–9). Recommendations for CS1–6 were correct in 79%, 66%, 39%, 27%, 28%, and 28%, respectively. The probability of a guideline-adherent recommendation increased with each patient treated per year in a clinic for CS1, CS2, CS3, and CS6 by 16%, 7.8%, 7.2%, and 9.5%, respectively (each p < 0.05); CS4 and CS5 were not influenced by caseload. A caseload threshold with a higher guideline adherence for all endpoints could not be perceived. The type of hospital care (academic vs. non-academic) did not affect guideline adherence in any scenario. Conclusions Guideline adherence for most treatment recommendations increases with growing annual penile cancer caseload. Thus, the results of our study call for a stronger centralization of diagnosis and treatment strategies regarding penile cancer.
Collapse
Affiliation(s)
- Steffen Lebentrau
- Department of Urology, Werner Forßmann Hospital, Eberswalde, Germany
| | | | - Martin Schostak
- Department of Urology and Urooncology, University Medical Center Magdeburg, Magdeburg, Germany
| | - Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Axel S Merseburger
- Department of Urology, University of Schleswig-Holstein, Lübeck, Germany
| | - Georg C Hutterer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Ulrike H Necknig
- Department of Urology and Pediatric Urology, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Bögemann
- Department of Urology and Pediatric Urology, University Medical Center Münster, Münster, Germany
| | - Luis Alex Kluth
- Department of Urology, University Medical Center Frankfurt a.M., Frankfurt/Main, Germany
| | - Armin Pycha
- Department of Urology, Hospital of Bolzano, Bolzano-Bozen, Italy.,Medical School, Sigmund Freud University Vienna, Vienna, Austria
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Sabine D Brookman-May
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Matthias May
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.,Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| |
Collapse
|
10
|
The prognostic value of lymph node ratio in comparison to positive lymph node count in penile squamous cell carcinoma. Int Urol Nephrol 2021; 53:2527-2540. [PMID: 34585313 PMCID: PMC8599252 DOI: 10.1007/s11255-021-02996-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/12/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Penile cancer is a rare male neoplasm with a wide variation in its global incidence. In this study, the prognostic value of lymph node ratio (LNR) was compared to that of positive lymph node count (PLNC) in penile squamous cell carcinoma. METHODS A total of 249 patients with penile squamous cell carcinoma were enrolled from The Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. The X-tile program was used to calculate the optimal cut-off values of LNR and PLNC that discriminate survival. We used the χ2 or the Fisher exact probability test to assess the association between clinical-pathological characteristics and LNR or PLNC. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors for survival. Spearman correlation analysis was used to determine the correlation between LNR and PLNC. RESULTS We found that patients with high LNR tended to have advanced N stage, the 7th AJCC stage, and higher pathological grade, while patients with high PLNC had advanced N stage and the 7th AJCC stage. Univariate Cox regression analysis revealed that the N stage, M stage, the 7th AJCC stage, lymph-vascular invasion, LNR, and PLNC were significantly associated with prognosis. Multivariate Cox regression analysis demonstrated that LNR rather than PLNC was an independent prognostic factor for cancer-specific survival. Subgroup analysis of node-positive patients showed that LNR was associated with CSS, while PLNC was not. CONCLUSION LNR was a better predictor for long-term prognosis than PLNC in patients with penile squamous cell carcinoma.
Collapse
|
11
|
Outcomes of perineal urethrostomy for penile cancer: A 20-year international multicenter experience. Urol Oncol 2021; 39:500.e9-500.e13. [PMID: 34134926 DOI: 10.1016/j.urolonc.2021.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Perineal urethrostomy (PU) is often the definitive form of urinary diversion in patients with locally-advanced or anatomically unfavorable penile cancer (PC) requiring total penectomy. Here, we report post-operative PU-related complications and PU stenosis rates after total penectomy with PU in a large multicenter cohort of PC patients. METHODS We retrospectively reviewed the medical records of 299 patients who underwent PU as a means of urinary diversion for primary PC across seven international centers from 2000 to 2020. The Clavien-Dindo grading system was used to record 30-day post-operative complications. Cumulative incidence of stenosis was evaluated using the Kaplan-Meier method. RESULTS Median patient age was 67 years (interquartile range (IQR) 58-74), and median follow-up was 19 months (IQR 7.2-57). A total of 58 patients (19%) developed a 30-day post-operative complication, of which 45 (79%) were deemed minor (CD Grade I and II). Wound infection (11%; CD grade I-III) and dehiscence (4.0%; CD grade I-III) were the more common complications. The overall incidence of stenosis was 12% (35/299 patients), of which 26 (74%) needed surgical revision (probability of stenosis revision at one year of 9.3%, median time until the revision: 6.1 months (IQR 3.0-13)). Only two stenoses were seen after two years of follow-up. CONCLUSION We present the most extensive series of PU in the management of PC to date. Wound infections of the primary surgical site were the most common complication. Stenosis occurred mostly within one and a half years after treatment.
Collapse
|
12
|
Chang EK, Sekar RR, Holt SK, Gore JL, Wright JL, Nyame YA. Underutilization of Surgical Standard of Care for Insured Men with Invasive Penile Cancer. UROLOGY PRACTICE 2021; 8:348-354. [PMID: 33898656 PMCID: PMC8063966 DOI: 10.1097/upj.0000000000000214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Prior studies of mixed insurance populations have demonstrated poor adherence to surgical standard of care (SOC) for penile cancer. We used data from the Surveillance, Epidemiology and End Results (SEER) cancer registry linked to Medicare to calculate SOC adherence to surgical treatment of penile cancer in insured men over the age of 65, focusing on potential social and racial disparities. METHODS This is an observational analysis of patients with T2-4 penile cancer of any histologic subtype without metastasis in the SEER-Medicare database (2004-2015). SOC was defined as penectomy (partial or radical) with bilateral inguinal lymph node dissection (ILND) based on the National Comprehensive Cancer Network guidelines. We calculated proportions of those receiving SOC and constructed multivariate models to identify factors associated with receiving SOC. RESULTS A total of 447 men were included. Of these men, 22.1% (99/447) received SOC while 18.8% (84/447) received no treatment at all. Only 23.3% (104/447) had ILND while 80.9% (362/447) underwent total or partial penectomy. Race and socioeconomic status (SES) were not associated with decreased SOC. Increasing age (OR 0.93, 95%CI:0.89-0.96), Charlson Comorbidity Index score ≥ 2 (OR 0.53, 95%CI:0.29-0.97), and T3-T4 disease (OR 0.34, 95%CI:0.18-0.65) were associated with not receiving SOC on adjusted analysis. CONCLUSIONS Rates of SOC are low among insured men 65 years of age or older with invasive penile cancer, regardless of race or SES. This finding is largely driven by low rates of ILND. Strategies are needed to overcome barriers to SOC treatment for men with invasive penile cancer.
Collapse
Affiliation(s)
- Edward K. Chang
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Rishi R. Sekar
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Sarah K. Holt
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - John L. Gore
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Division of Public Health Sciences, Fred Hutchinson Center Research Center, Seattle, Washington
| | - Jonathan L. Wright
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Division of Public Health Sciences, Fred Hutchinson Center Research Center, Seattle, Washington
| | - Yaw A. Nyame
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Division of Public Health Sciences, Fred Hutchinson Center Research Center, Seattle, Washington
| |
Collapse
|
13
|
Panic A, Reis H, Wittka A, Darr C, Hadaschik B, Jendrossek V, Klein D. The Biomarker Potential of Caveolin-1 in Penile Cancer. Front Oncol 2021; 11:606122. [PMID: 33868995 PMCID: PMC8045968 DOI: 10.3389/fonc.2021.606122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/12/2021] [Indexed: 01/11/2023] Open
Abstract
Various types of human cancers were characterized by an altered expression of epithelial or stromal caveolin-1 (CAV1). However, the clinical significance of CAV1 expression in penile cancer remains largely unknown. Here the expression patterns of CAV1 were analyzed in a retrospective cohort (n=43) of penile squamous cell carcinomas (SCC). Upon penile cancer progression, significantly increased CAV1-levels were determined within the malignant epithelium, whereas within the tumor stroma, namely the fibroblastic tumor compartment harboring activated and/or cancer associated fibroblasts, CAV1 levels significantly decline. Concerning the clinicopathological significance of CAV1 expression in penile cancer as well as respective epithelial-stromal CAV1 distributions, high expression within the tumor cells as well as low expression of CAV1 within the stromal compartment were correlated with decreased overall survival of penile cancer patients. Herein, CAV1 expressions and distributions at advanced penile cancer stages were independent of the immunohistochemically proven tumor protein p53 status. In contrast, less differentiated p16-positive tumor epithelia (indicative for human papilloma virus infection) were characterized by significantly decreased CAV1 levels. Conclusively, we provide further and new evidence that the characteristic shift in stromal‐epithelial CAV1 being functionally relevant to tumor progression even occurs in penile SCC.
Collapse
Affiliation(s)
- Andrej Panic
- Department of Urology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Henning Reis
- Institute of Pathology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Alina Wittka
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, University Hospital, Essen, Germany
| | - Christopher Darr
- Department of Urology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Verena Jendrossek
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, University Hospital, Essen, Germany
| | - Diana Klein
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, University Hospital, Essen, Germany
| |
Collapse
|
14
|
Schmid SC, Seitz AK, Haller B, Fritsche HM, Huber T, Burger M, Gschwend JE, Maurer T. Final results of the PräVAC trial: prevention of wound complications following inguinal lymph node dissection in patients with penile cancer using epidermal vacuum-assisted wound closure. World J Urol 2021; 39:613-620. [PMID: 32372159 PMCID: PMC7910363 DOI: 10.1007/s00345-020-03221-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/21/2020] [Indexed: 10/29/2022] Open
Abstract
PURPOSE Inguinal lymphadenectomy in penile cancer is associated with a high rate of wound complications. The aim of this trial was to prospectively analyze the effect of an epidermal vacuum wound dressing on lymphorrhea, complications and reintervention in patients with inguinal lymphadenectomy for penile cancer. PATIENTS AND METHODS Prospective, multicenter, randomized, investigator-initiated study in two German university hospitals (2013-2017). Thirty-one patients with penile cancer and indication for bilateral inguinal lymph node dissection were included and randomized to conventional wound care on one side (CONV) versus epidermal vacuum wound dressing (VAC) on the other side. RESULTS A smaller cumulative drainage fluid volume until day 14 (CDF) compared to contralateral side was observed in 15 patients (CONV) vs. 16 patients (VAC), with a median CDF 230 ml (CONV) vs. 415 ml (VAC) and a median maximum daily fluid volume (MDFV) of 80 ml (CONV) vs. 110 ml (VAC). Median time of indwelling drainage: 7 days (CONV) vs. 8 days (VAC). All grade surgery-related complications were seen in 74% patients (CONV) vs. 74% patients (VAC); grade 3 complications in 3 patients (CONV) vs. 6 patients (VAC). Prolonged hospital stay occurred in 32% patients (CONV) vs. 48% patients (VAC); median hospital stay was 11.5 days. Reintervention due to complications occurred in 45% patients (CONV) vs. 42% patients (VAC). CONCLUSIONS In this prospective, randomized trial we could not observe a significant difference between epidermal vacuum treatment and conventional wound care.
Collapse
Affiliation(s)
- Sebastian C Schmid
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Ismaningerstr. 22, 81375, Munich, Germany.
| | - Anna K Seitz
- Department of Urology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | | | - Toni Huber
- Department of Urology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Jürgen E Gschwend
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Ismaningerstr. 22, 81375, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Ismaningerstr. 22, 81375, Munich, Germany
- Department of Urology and Martini-Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
15
|
Thomas A, Kölling F, Haferkamp A, Tsaur I. [Quality of care criteria in the treatment of penile cancer]. Urologe A 2021; 60:186-192. [PMID: 33452551 DOI: 10.1007/s00120-020-01429-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Penile cancer is a rare malignancy and the wide range of quality of care associated with it often results in inferior oncologic and functional treatment outcomes. OBJECTIVES Assessment of the current healthcare situation in clinical routine and identification of the relevant key features and reference values for quality of care. MATERIALS AND METHODS Search for relevant peer-reviewed articles and published congress abstracts in Medline, Embase and other databases as well as Google web search engine. RESULTS Key quality features of penile cancer management include organ-sparing surgery of the primary tumor, invasive inguinal lymph node staging and systemic treatment. Adherence to treatment guidelines is currently low. Centralization of care has already led to a considerable improvement in the quality of care in some areas and increasing conformity with the guidelines' recommendations. CONCLUSION Centralization of care and networks based on this can significantly improve patient outcomes. Thus, reference values for core parameters of quality cancer care can be generated and validated. Moreover, organ-sparing surgery, invasive lymph node staging and systemic therapy should be increasingly utilized. As a reference value, 90% adherence to the guidelines for these three features is recommended. However, before centralization of care can be introduced, aspects relevant to practical implementation must be addressed, such as the reimbursement of travel costs for those affected, infrastructure costs and instruments to measure quality of life and patient satisfaction after centralization.
Collapse
Affiliation(s)
- A Thomas
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - F Kölling
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - A Haferkamp
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - I Tsaur
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| |
Collapse
|
16
|
Pallauf M, Hempel MC, Hupe MC, May M, Haccius M, Weckermann D, Lebentrau S, Hoschke B, Necknig U, Pfitzenmaier J, Manka L, Nuhn P, Törzsök P, Lusuardi L, Merseburger AS. Adherence to the EAU Guideline Recommendations for Local Tumor Treatment in Penile Cancer: Results of the European PROspective Penile Cancer Study Group Survey (E-PROPS). Adv Ther 2020; 37:4969-4980. [PMID: 33038006 PMCID: PMC7595959 DOI: 10.1007/s12325-020-01514-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
Introduction Penile cancer (PeCa) is an orphan disease in European countries. The current guidelines are predominantly based on retrospective studies with a low level of evidence. In our study, we aimed to identify predictors for guideline-conform treatment and hypothesize that reference centers for PeCa and physicians' experience promote guideline compliance and therefore correct local tumor therapy. Methods This study is part of the European PROspective Penile Cancer Study (E-PROPS), an international collaboration group evaluating therapeutic management for PeCa in Central Europe. For this module, a 14-item-survey was developed and sent to 681 urologists in 45 European centers. Three questions focused on therapeutic decisions for PeCa in clinical stage Tis, Ta-T1a, and T1b. Four questions addressed potential personal confounders. Survey results were analyzed by bootstrap-adjusted stepwise multivariate linear regression analysis to identify predictors for EAU guideline-conform local treatment of PeCa. Results For local therapy of cTis 80.4% recommended guideline-conform treatment, for cTa-cT1a 87.3% and for cT1b 59.1%. In total, 42.4% chose a correct approach in all tumor stages. The number of PeCa patients treated at the hospital, a higher level of training of the physicians, resource-based answering and the option of penile-sparing surgery offered at the hospital matched with giving guideline-conform recommendations and thus accurate local tumor treatment. Conclusion Patients with PeCa are best treated by experienced physicians, in centers with a high number of cases, which also offer a wide range of local tumor therapy. This could be offered in reference centers.
Collapse
Affiliation(s)
- Maximilian Pallauf
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Marie C Hempel
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
| | - Marie C Hupe
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany
| | - Marlene Haccius
- Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany
| | | | - Steffen Lebentrau
- Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany
| | - Bernd Hoschke
- Department of Urology, Carl-Thiem-Clinic Cottbus, Cottbus, Germany
| | - Ulrike Necknig
- Department of Urology and Pediatric Urology, Garmisch-Partenkirchen Medical Center, Garmisch-Partenkirchen, Germany
| | | | - Lukas Manka
- Clinic of Braunschweig, Braunschweig, Germany
| | - Philipp Nuhn
- Department of Urology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Törzsök
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| |
Collapse
|
17
|
Peniskarzinom: Wie gut werden die Therapieempfehlungen umgesetzt? Aktuelle Urol 2020; 51:520-522. [PMID: 33232992 DOI: 10.1055/a-1019-5665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
18
|
May M, Rink M, Merseburger AS, Brookman-May SD. Why is the principle of "as much radicality as needed, as much organ preservation as possible" only insufficiently implemented in daily practice in the surgical treatment of penile cancer patients? Transl Androl Urol 2020; 9:1901-1903. [PMID: 33209653 PMCID: PMC7658148 DOI: 10.21037/tau-20-1152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Matthias May
- Department of Urology, St. Elisabeth-Hospital, Straubing, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Sabine D Brookman-May
- Department of Urology, Ludwig-Maximilians University, Campus Grosshadern, Munich, Germany.,Janssen Research and Development Oncology, Los Angeles, CA, USA
| |
Collapse
|
19
|
Distler FA, Pahernik S, Gakis G, Hutterer G, Lebentrau S, Rink M, Nuhn P, Brookman-May S, Burger M, Gratzke C, Wolff I, May M. Adherence to the EAU guideline recommendations for systemic chemotherapy in penile cancer: results of the E-PROPS study group survey. World J Urol 2019; 38:2523-2530. [PMID: 31834472 DOI: 10.1007/s00345-019-03052-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/06/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To validate the adherence of urologists to chemotherapy recommendations given in the EAU guidelines on PeCa. The European Association of Urology (EAU) guidelines on penile cancer (PeCa) are predominantly based on retrospective studies with low level of evidence. MATERIALS AND METHODS A 14-item-survey addressing general issues of PeCa treatment was developed and sent to 45 European hospitals. 557 urologists participated in the survey of which 43.5%, 19.3%, and 37.2% were in-training, certified, and in leading positions, respectively. Median response rate among participating departments was 85.7% (IQR 75-94%). Three of 14 questions addressed clinical decisions on neoadjuvant, adjuvant, and palliative chemotherapy. Survey results were analyzed by bootstrap-adjusted multivariate logistic-regression-analysis to identify predictors for chemotherapy recommendations consistent with the guidelines. RESULTS Neoadjuvant, adjuvant, and palliative chemotherapy was recommended according to EAU guidelines in 21%, 26%, and 48%, respectively. For neoadjuvant chemotherapy, urologists holding leading positions or performing chemotherapy were more likely to recommend guideline-consistent treatment (OR 1.85 and 1.92 with p(bootstrap) = 0.007 and 0.003, respectively). Supporting resources (i.e., guidelines, textbooks) were used by 23% of survey participants and significantly improved consistency between treatment recommendations and Guideline recommendations in all chemotherapy settings (p(bootstrap) = 0.010-0.001). Department size and university center status were no significant predictors for all three endpoints. CONCLUSIONS In this study, we found a very low rate of adherence to the EAU guidelines on systemic treatment for PeCa. Further investigations are needed to clarify whether this missing adherence is a consequence of limited individual knowledge level or of the low grade of guideline recommendations.
Collapse
Affiliation(s)
- F A Distler
- Department of Urology, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
| | - S Pahernik
- Department of Urology, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - G Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany
| | - G Hutterer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - S Lebentrau
- Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Nuhn
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Brookman-May
- Department of Urology, Großhadern, LMU Munich, Munich, Germany
| | - M Burger
- Department of Urology, St. Josef-Hospital Regensburg, Medical University Regensburg, Regensburg, Germany
| | - C Gratzke
- Department of Urology, University of Freiburg, Freiburg, Germany
| | - I Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - M May
- Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany
| |
Collapse
|
20
|
Making surgery safer by centralization of care: impact of case load in penile cancer. World J Urol 2019; 38:1385-1390. [DOI: 10.1007/s00345-019-02866-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022] Open
|