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Ottenhof SR, Djajadiningrat RS, Versleijen MWJ, Donswijk ML, van der Noort V, Brouwer OR, Graafland NM, Vegt E, Horenblas S. F-18 Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography Has High Diagnostic Value for Pelvic and Distant Staging in Patients with High-risk Penile Carcinoma. Eur Urol Focus 2021; 8:98-104. [PMID: 33685842 DOI: 10.1016/j.euf.2021.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/25/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND For penile cancer patients with pelvic metastases, multimodal treatment is advised, but pelvic lymph node metastases are often found upon surgical resection only. Early selection for multimodal treatment requires reliable noninvasive staging. OBJECTIVE To evaluate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) for staging pelvic lymph nodes and distant metastases in high-risk penile cancer patients. DESIGN, SETTING, AND PARTICIPANTS FDG-PET/CT scans performed in patients with clinically overt inguinal lymph node metastases and/or high-risk primary tumors (bulky T3 or T4) were retrospectively analyzed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS All scans were reviewed by two independent nuclear medicine physicians staging the pelvic nodes and distant metastases. FDG-PET/CT findings were compared with histology after node dissection if available, or with positive imaging or follow-up of at least 1 yr. RESULTS AND LIMITATIONS Between 2006 and 2016, 61 patients met the inclusion criteria. For staging of pelvic nodes, sensitivity was 85% (specificity 75%, negative predictive value [NPV] 90%, and positive predictive value [PPV] 65%). For the detection of distant metastases, FDG-PET/CT had a PPV of 93%. Results are limited by the retrospective design and the lack of direct comparison with CT scanning alone. CONCLUSIONS FDG-PET/CT has high sensitivity and a high NPV for staging of pelvic lymph nodes in high-risk penile cancer. It also has a high PPV for the detection of distant metastases, which were found in 23% of patients. Therefore, FDG-PET/CT enables early selection for multimodal treatment of patients with pelvic metastases and may help avoid futile treatment of patients with distant metastases. PATIENT SUMMARY We studied whether positron emission tomography with computed tomography (PET/CT) scans in patients with advanced penile cancer can detect metastases before lymph node surgery is done. PET/CT scans can detect or rule out pelvic lymph node metastases, and can detect distant metastases. This helps in making timely treatment decisions (before surgery).
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Affiliation(s)
- Sarah R Ottenhof
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | | | | | - Maarten L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Oscar R Brouwer
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Niels M Graafland
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Djajadiningrat RS, Walz J, van Dijk LC, Roshani H. Antegrade pyelography, a survey among urologists. Ir J Med Sci 2020; 189:843-848. [DOI: 10.1007/s11845-020-02180-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/21/2020] [Indexed: 12/01/2022]
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Ottenhof SR, Leone A, Djajadiningrat RS, Azizi M, Zargar K, Kidd LC, Diorio G, Mosiello G, Graafland NM, Spiess PE, Horenblas S. Surgical and Oncological Outcomes in Patients After Vascularised Flap Reconstruction for Locoregionally Advanced Penile Cancer. Eur Urol Focus 2019; 5:867-874. [DOI: 10.1016/j.euf.2018.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/13/2018] [Accepted: 02/01/2018] [Indexed: 11/24/2022]
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Necchi A, Pond GR, Raggi D, Ottenhof SR, Djajadiningrat RS, Horenblas S, Khoo V, Hakenberg OW, Draeger D, Protzel C, Heidenreich A, Haidl F, Eigl BJ, Nappi L, Matsumoto K, Vaishampayan U, Woods ME, Salvioni R, Nicolai N, Catanzaro M, Giannatempo P, Geynisman DM, Preto M, Xylinas E, Milowsky MI, De Placido S, Di Lorenzo G, Sonpavde G. Clinical Outcomes of Perioperative Chemotherapy in Patients With Locally Advanced Penile Squamous-Cell Carcinoma: Results of a Multicenter Analysis. Clin Genitourin Cancer 2017; 15:548-555.e3. [PMID: 28325636 DOI: 10.1016/j.clgc.2017.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/03/2017] [Accepted: 02/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prognosis of patients with locally advanced penile squamous-cell carcinoma is primarily related to the extent of lymph node metastases. Surgery alone yields suboptimal results, and there is a paucity of data on these patients' outcomes. PATIENTS AND METHODS This retrospective study evaluated patients who received neoadjuvant or adjuvant chemotherapy from 1990 onward at 12 centers. Cox models were used to investigate prognostic factors for relapse-free survival and overall survival (OS). RESULTS Among the 201 included patients, 39 (19.4%) had disease of T3-4 and N0 clinical stage; the remaining patients had clinical lymph node involvement (cN+). Ninety-four patients received neoadjuvant chemotherapy (group 1), 78 received adjuvant chemotherapy (group 2), and 21 received both (group 3). Eight patients for whom the timing of perioperative chemotherapy administration was unavailable were included in the Cox analyses. Forty-three patients (21.4%) received chemoradiation. Multivariate analysis for OS (n = 172) revealed bilateral disease (P = .035) as a negative prognostic factor, while pelvic cN+ tended to be nonsignificantly associated with decreased OS (P = .076). One-year relapse-free survival was 35.6%, 60.6%, and 45.1% in the 3 groups, respectively. One-year OS was 61.3%, 82.2%, and 75%, respectively. No significant differences were seen on univariable analyses for OS between the groups (P = .45). Platinum type of chemotherapy and chemoradiation were not significantly associated with any outcome analyzed. CONCLUSION Benchmark survival estimates for patients receiving perioperative chemotherapy for locally advanced penile squamous-cell carcinoma have been provided, with no substantial differences observed between neoadjuvant and adjuvant administration. This analysis may result in improved patient information, although prospective studies are warranted.
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Affiliation(s)
- Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | | | - Daniele Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Simon Horenblas
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Vincent Khoo
- The Royal Marsden Hospital, London, United Kingdom
| | | | | | | | | | | | - Bernie J Eigl
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Lucia Nappi
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | | | - Michael E Woods
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Nicola Nicolai
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mario Catanzaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Mirko Preto
- Università degli Studi di Torino, Ospedale Molinette, Torino, Italy
| | | | - Matthew I Milowsky
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Ottenhof SR, Djajadiningrat RS, de Jong J, Thygesen HH, Horenblas S, Jordanova ES. Expression of Programmed Death Ligand 1 in Penile Cancer is of Prognostic Value and Associated with HPV Status. J Urol 2016; 197:690-697. [PMID: 27697578 DOI: 10.1016/j.juro.2016.09.088] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE PD-L1 (programmed death ligand 1) inhibits T-cell function and prevents tumor eradication. This is facilitated by PD-L1 positive tumor cells and PD-L1 positive immune cells, and can be prevented by anti-PD-1 (programmed death 1)/PD-L1 immunotherapy. In advanced penile cancer there is a need for new therapeutic strategies. We investigated PD-L1 expression in penile cancers and compared PD-L1 expression with disease specific survival, lymph node metastases at diagnosis and high risk HPV status in a large patient cohort. MATERIALS AND METHODS A total of 213 primary tumors were immunohistochemically stained for PD-L1 and scored for tumor (percentage), stroma (binary) and PD-L1 positive tumor infiltrating macrophages. Additionally, PD-L1 positive tumors were scored for expression pattern, that is diffuse or predominantly present at the tumor-stroma margin. RESULTS Staining was successful in 200 tumors, of which 75% were high risk HPV negative. Median followup was 62 months. Of 200 tumors 96 (48%) were PD-L1 positive (scored 1% or greater), of which 59 (62%) had a marginal expression pattern and 79 (82%) were high risk HPV negative (p = 0.03). Compared to PD-L1 negative tumors, the PD-L1 expression patterns had different prognostic values in the whole cohort as well as in the high risk HPV negative subgroup. On multivariable analyses a marginal expression pattern was associated with absent lymph node metastases (OR 0.4) while diffuse expression was associated with poor survival (HR 2.58). These results were more prominent in the high risk HPV negative subgroup (OR 0.25, HR 3.92). CONCLUSIONS PD-L1 was expressed in 48% of penile carcinomas and mainly in high risk HPV negative tumors. The pattern of expression was a prognostic factor as marginal expression was associated with absent lymph node metastases and diffuse expression was associated with poor survival.
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Affiliation(s)
- Sarah R Ottenhof
- Department of Urological Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Rosa S Djajadiningrat
- Department of Urological Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen de Jong
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Helene H Thygesen
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urological Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ekaterina S Jordanova
- Center Gynecological Oncology Amsterdam, Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
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Djajadiningrat RS, van Werkhoven E, Horenblas S. Prophylactic Pelvic Lymph Node Dissection in Patients with Penile Cancer. J Urol 2015; 193:1976-80. [DOI: 10.1016/j.juro.2014.12.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Rosa S. Djajadiningrat
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Sun M, Djajadiningrat RS, Alnajjar HM, Trinh QD, Graafland NM, Watkin N, Karakiewicz PI, Horenblas S. Development and external validation of a prognostic tool for prediction of cancer-specific mortality after complete loco-regional pathological staging for squamous cell carcinoma of the penis. BJU Int 2015; 116:734-43. [DOI: 10.1111/bju.12677] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Maxine Sun
- Department of Urology; Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Rosa S. Djajadiningrat
- Department of Urology; Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital; Amsterdam the Netherlands
| | | | - Quoc-Dien Trinh
- Department of Urology; Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Niels M. Graafland
- Department of Urology; Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital; Amsterdam the Netherlands
| | - Nick Watkin
- Penile Cancer Centre; St George's Healthcare NHS Trust; London UK
| | - Pierre I. Karakiewicz
- Department of Urology; Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Simon Horenblas
- Department of Urology; Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital; Amsterdam the Netherlands
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Gopman JM, Djajadiningrat RS, Baumgarten AS, Espiritu PN, Horenblas S, Zhu Y, Protzel C, Pow-Sang JM, Kim T, Sexton WJ, Poch MA, Spiess PE. Predicting postoperative complications of inguinal lymph node dissection for penile cancer in an international multicentre cohort. BJU Int 2015; 116:196-201. [PMID: 25777366 DOI: 10.1111/bju.13009] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the potential complications associated with inguinal lymph node dissection (ILND) across international tertiary care referral centres, and to determine the prognostic factors that best predict the development of these complications. MATERIALS AND METHODS A retrospective chart review was conducted across four international cancer centres. The study population of 327 patients underwent diagnostic/therapeutic ILND. The endpoint was the overall incidence of complications and their respective severity (major/minor). The Clavien-Dindo classification system was used to standardize the reporting of complications. RESULTS A total of 181 patients (55.4%) had a postoperative complication, with minor complications in 119 cases (65.7%) and major in 62 (34.3%). The total number of lymph nodes removed was an independent predictor of experiencing any complication, while the median number of lymph nodes removed was an independent predictor of major complications. The American Joint Committee on Cancer stage was an independent predictor of all wound infections, while the patient's age, ILND with Sartorius flap transposition, and surgery performed before the year 2008 were independent predictors of major wound infections. CONCLUSIONS This is the largest report of complication rates after ILND for squamous cell carcinoma of the penis and it shows that the majority of complications associated with ILND are minor and resolve without prolonged morbidity. Variables pertaining to the extent of disease burden have been found to be prognostic of increased postoperative morbidity.
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Affiliation(s)
- Jared M Gopman
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Rosa S Djajadiningrat
- Department of Urological Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Adam S Baumgarten
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Patrick N Espiritu
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Simon Horenblas
- Department of Urological Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Yao Zhu
- Department of Urological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chris Protzel
- Department of Urology, University of Rostock, Rostock, Germany
| | - Julio M Pow-Sang
- Department of Urological Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Timothy Kim
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael A Poch
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
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Djajadiningrat RS, Bergman AM, van Werkhoven E, Vegt E, Horenblas S. Neoadjuvant Taxane-Based Combination Chemotherapy in Patients With Advanced Penile Cancer. Clin Genitourin Cancer 2015; 13:44-9. [DOI: 10.1016/j.clgc.2014.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/06/2014] [Accepted: 06/03/2014] [Indexed: 12/26/2022]
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Djajadiningrat RS, van Werkhoven E, Horenblas S. Penile cancer stage, survival and body mass index. Urol Int 2015; 94:220-4. [PMID: 25612647 DOI: 10.1159/000367927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether a higher body mass index (BMI) in penile cancer patients is associated with more advanced penile cancer stage at the time of treatment and cancer survival. METHODS We evaluated 433 penile cancer patients treated between 2006 and 2012 at our institute and recorded American Joint Committee on Cancer (AJCC) stage, BMI, circumcision, smoking and age. A proportional odds model was used to assess a possible association between BMI and AJCC stage at diagnosis and controlled for circumcision, smoking and age. Five-year disease-specific survival was calculated using the Kaplan-Meier method, with the log-rank test assessing equality of distributions. RESULTS 433 patients with a mean BMI of 26.8 kg/m2 were analyzed. No statistically significant association between BMI and AJCC stage was found (odds ratio 1.01 per 1 kg/m2 increase in BMI, 95% confidence interval 0.97-1.05, p=0.63). Differences in disease-specific survival were not observed based on the different BMI classes. CONCLUSIONS No association between BMI of penile cancer patients and their disease stage at the time of treatment was observed. Thus, BMI at penile cancer treatment does not affect prognosis.
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Djajadiningrat RS, Jordanova ES, Kroon BK, van Werkhoven E, de Jong J, Pronk DTM, Snijders PJF, Horenblas S, Heideman DAM. Human papillomavirus prevalence in invasive penile cancer and association with clinical outcome. J Urol 2014; 193:526-31. [PMID: 25150641 DOI: 10.1016/j.juro.2014.08.087] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 01/21/2023]
Abstract
PURPOSE The incidence of penile cancer is increasing, and is suggested to be explained by changes in sexual practice and increased exposure of men to sexually transmitted high risk human papillomavirus infection. In penile cancers from a Dutch population treated in 1963 to 2001 we found a high risk human papillomavirus prevalence of about 30%. In this study we assessed the prevalence of high risk human papillomavirus-DNA in a more recent, contemporary penile cancer cohort and its association with patient survival. MATERIALS AND METHODS High risk human papillomavirus-DNA presence was assessed by GP5+6+ polymerase chain reaction in 212 formalin fixed, paraffin embedded invasive penile tumor specimens of patients treated between 2001 and 2009. The 5-year disease specific survival was calculated using the Kaplan-Meier method with the log rank test and Cox regression. RESULTS High risk human papillomavirus-DNA was detected in a subset of penile cancer cases (25%, 95% CI 19-31). HPV16 was the predominant type, representing 79% (42 of 53) of all high risk human papillomavirus infections. The 5-year disease specific survival in the high risk human papillomavirus negative group and the high risk human papillomavirus positive group was 82% and 96%, respectively (log rank test p=0.016). Adjusted for stage, grade, lymphovascular invasion and age, human papillomavirus status was still prognostic for disease specific survival (p=0.030) with a hazard ratio of 0.2 (95% CI 0.1-0.9). CONCLUSIONS High risk human papillomavirus-DNA was observed in a quarter of penile cancer cases. No relevant increase in high risk human papillomavirus prevalence in recent decades was observed. The presence of high risk human papillomavirus-DNA in penile cancer confers a survival advantage.
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Affiliation(s)
| | - Ekaterina S Jordanova
- Centre for Gynaecologic Oncology Amsterdam, Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Bin K Kroon
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen de Jong
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Divera T M Pronk
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Djajadiningrat RS, van Werkhoven E, Meinhardt W, van Rhijn BW, Bex A, van der Poel HG, Horenblas S. Penile Sparing Surgery for Penile Cancer—Does it Affect Survival? J Urol 2014; 192:120-5. [DOI: 10.1016/j.juro.2013.12.038] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 01/09/2023]
Affiliation(s)
- Rosa S. Djajadiningrat
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands
| | - Wim Meinhardt
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands
| | - Bas W.G. van Rhijn
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands
| | - Axel Bex
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands
| | - Henk G. van der Poel
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands
| | - Simon Horenblas
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands
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Kieffer JM, Djajadiningrat RS, van Muilekom EAM, Graafland NM, Horenblas S, Aaronson NK. Quality of life for patients treated for penile cancer. J Urol 2014; 192:1105-10. [PMID: 24747092 DOI: 10.1016/j.juro.2014.04.014] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE We assessed the impact of primary surgery, including penile sparing surgery vs (partial) penectomy and lymphadenectomy, on sexuality and health related quality of life. MATERIALS AND METHODS We invited 147 patients surgically treated for penile cancer at our institution between 2003 and 2008 to complete the IIEF-15, SF-36®, IOC (version 2) and questions on urinary function. We evaluated the impact of primary surgery type and lymphadenectomy on these outcomes. We also compared patient SF-36 scores with those of an age and gender matched normative sample from the general Dutch population. RESULTS A total of 90 patients (62%) returned a completed questionnaire. Surgery type and extent were not associated significantly with most of the study outcomes assessed. However, men who underwent (partial) penectomy reported significantly more problems than those treated with penile sparing surgery, including orgasm (effect size 0.54, p = 0.031), appearance concerns (effect size 0.61, p = 0.008), life interference (effect size 0.49, p = 0.032) and urinary function (83% vs 43%, p <0.0001). Men who underwent lymphadenectomy reported significantly more life interference (effect size 0.50, p = 0.037). The patient sample scored significantly better than the normative sample on the SF-36 physical component (p = 0.044) and the bodily pain subscale (p <0.001). CONCLUSIONS Few differences were observed in sexuality and health related quality of life as a function of primary surgery and lymphadenectomy. However, (partial) penectomy and lymphadenectomy were associated with more problems with orgasm, body image, life interference and urination. Additional longitudinal studies are warranted to evaluate individual changes with time in these outcomes.
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Affiliation(s)
- Jacobien M Kieffer
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | | | - Niels M Graafland
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
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Gopman JM, Djajadiningrat RS, Horenblas SI, Zhu Y, Protzel C, Sexton WJ, Pow-Sang J, Espiritu PN, Kim TJ, Spiess PE. PD5-08 CONTEMPORARY OUTCOMES OF INGUINAL LYMPH NODE DISSECTION FOR PENILE CANCER IN A MULTICENTER INTERNATIONAL COHORT. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Yao Zhu
- Shanghai, China, People's Republic of
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Popa I, Sun M, Djajadiningrat RS, Gandaglia G, Schiffmann J, Azizi M, Trudeau V, Hanna N, Trinh QD, Karakiewicz PI, Horenblas S. MP10-19 DEVELOPMENT AND EXTERNAL VALIDATION OF A PROGNOSTIC TOOL FOR PREDICTION OF CANCER-SPECIFIC MORTALITY AFTER COMPLETE LOCO-REGIONAL PATHOLOGICAL STAGING FOR SQUAMOUS CELL CARCINOMA OF THE PENIS. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Djajadiningrat RS, Teertstra HJ, van Werkhoven E, van Boven HH, Horenblas S. Ultrasound examination and fine needle aspiration cytology-useful for followup of the regional nodes in penile cancer? J Urol 2013; 191:652-5. [PMID: 23994372 DOI: 10.1016/j.juro.2013.08.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE Routine followup of the groins of patients with penile squamous cell carcinoma after primary treatment consists of physical examination together with ultrasound of the groins, followed by fine needle aspiration cytology if suspicious. We assessed the value of this routine followup. MATERIALS AND METHODS Using ultrasound and fine needle aspiration cytology we assessed 247 patients during followup who were treated from 2004 to 2010 and underwent dynamic sentinel node biopsy only or observation of the inguinal regions. A negative result was defined as no evidence of metastatic disease after at least 2 years of followup. We calculated the sensitivity, specificity, and positive and negative predictive values of ultrasound and ultrasound guided fine needle aspiration cytology using standard statistical methods. RESULTS Recurrence was diagnosed in 47 of 247 patients (55 groins). In 40 of 55 groins (73%) recurrence was detectable by physical examination. In 12 of 15 cases of nonpalpable recurrence (80%) ultrasound guided fine needle aspiration cytology revealed the recurrence. We considered 217 groins to be suspicious on ultrasound followed by fine needle aspiration cytology. Fine needle aspiration cytology revealed tumor in 49 groins and showed false-positive findings in 1 patient after negative completion lymphadenectomy. Sensitivity and specificity were 87.3% (48 of 55 cases) and 99.9% (1,304 of 1,305), respectively. CONCLUSIONS Although inguinal recurrence manifests clinically in most patients, ultrasound guided fine needle aspiration cytology detected 80% of metastatic disease in patients with nonpalpable disease. Therefore, it has great value for detecting lymph node metastases during followup.
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Affiliation(s)
| | - H Jelle Teertstra
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hester H van Boven
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Djajadiningrat RS, Graafland NM, van Werkhoven E, Meinhardt W, Bex A, van der Poel HG, van Boven HH, Valdés Olmos RA, Horenblas S. Contemporary management of regional nodes in penile cancer-improvement of survival? J Urol 2013; 191:68-73. [PMID: 23917166 DOI: 10.1016/j.juro.2013.07.088] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE The management of regional nodes of penile squamous cell carcinoma has changed with time due to improved knowledge about diagnosis and treatment. To determine whether changes in the treatment of regional nodes have improved survival, we compared contemporary 5-year cancer specific survival of patients with squamous cell carcinoma of the penis with that of patients in previous cohorts. MATERIALS AND METHODS In an observational cohort study of 1,000 patients treated during 56 years 944 were eligible for analysis. Tumors were staged according to the 2009 TNM classification, and patients were divided into 4 cohorts of 1956 to 1987, 1988 to 1993, 1994 to 2000 and 2001 to 2012, reflecting changes in clinical practice regarding regional nodes. Kaplan-Meier survival curves with the log rank test and Cox proportional hazards modeling were used to examine trends in 5-year cancer specific survival. RESULTS The 5-year cancer specific survival of patients with cN0 disease treated between 2001 and 2012 was 92% compared to 89% (1994 to 2000), 78% (1988 to 1993) and 85% (1956 to 1987). The 5-year cancer specific survival improved significantly since 1994, the year dynamic sentinel node biopsy was introduced, at 91% (1994 to 2012) vs 82% (1956 to 1993) (p = 0.021). This conclusion still holds after adjustment for pathological T stage and grade of differentiation (HR 2.46, p = 0.01). Extranodal extension, number of tumor positive nodes and pelvic involvement in node positive (pN+) cases were associated with worse 5-year cancer specific survival. CONCLUSIONS Despite less surgery being performed on regional nodes, 5-year cancer specific survival has improved in patients with cN0 disease. The number of tumor positive nodes, extranodal extension and pelvic involvement were highly associated with worse cancer specific survival in patients with pN+ disease. In this group other treatment strategies are needed as no improvement was observed.
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Affiliation(s)
| | - Niels M Graafland
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wim Meinhardt
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hester H van Boven
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Renato A Valdés Olmos
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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