TY - JOUR
T1 - Optimising the selection of candidates for neoadjuvant chemotherapy amongst patients with node-positive penile squamous cell carcinoma.
AU - Bandini, Marco
AU - Albersen, Maarten
AU - Chipollini, Juan
AU - Pederzoli, Filippo
AU - Zhu, Yao
AU - Ye, Ding-Wei
AU - Ornellas, Antonio A.
AU - Watkin, Nick
AU - Ager, Michael
AU - Hakenberg, Oliver W.
AU - Heidenreich, Axel
AU - Raggi, Daniele
AU - Catanzaro, Mario
AU - Haidl, Friederike
AU - Mazzone, Elio
AU - Marandino, Laura
AU - Briganti, Alberto
AU - Montorsi, Francesco
AU - Azizi, Mounsif
AU - Spiess, Philippe E.
AU - Necchi, Andrea
N1 - Place: England
PY - 2020/6/1
Y1 - 2020/6/1
N2 - OBJECTIVES: To identify predictors of poor overall survival (OS) amongst patients with penile squamous cell carcinoma (pSCC) with clinical inguinal lymphadenopathy (cN+), in order to define the best candidates for neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS: Using an international, multicentre database of 924 patients with pSCC, we identified 334 men who harboured cN+ with available clinical and follow-up data. Lymph node involvement was defined either by the presence of palpable inguinal node disease or by preoperative computed tomography (CT) assessment. Fluorine-18 fluorodeoxyglucose positron-emission tomography ((18) F-FDG-PET)/CT scan was performed based on clinical judgment of the treating physician. Regression-tree analysis generated a risk stratification tool for prediction of 24-month overall mortality (OM). Kaplan-Meier explored the OS benefit related to the use of NAC according to the regression-tree-stratified subgroups. RESULTS: Overall, 120 (35.9, 152 (45.5, and 62 (18.6 patients harboured cN1, cN2, and cN3 disease. (18) F-FDG-PET/CT was performed in 48 (14.4 patients, and 16 (4.8 had inguinal and pelvic nodal PET detection. The median OS was 107 months, with a 24-month OS of 66tree analysis (area under the curve = 70, patients with cN3 and cN2 with PET/CT-detected inguinal and pelvic nodal activity had a higher risk of 24-month OM (textgreater50. NAC was associated with improved 24-month OS rates (543 only in this subgroup of patients (P = 0.002), which was also confirmed after multivariable adjustment (hazard ratio 0.28, 95.13-0.62; P = 0.002). CONCLUSION: Patients with pSCC with cN3 or cN2 and inguinal and pelvic 18F-FDG-PET/CT scan detected disease had higher 24-month OM rates according to our regression-tree model. NAC was associated with improved OS only in these subgroups of patients. Our novel decision model may help to stratify cN+ patients, and identify those who most likely will benefit from NAC prior to radical surgical resection.
AB - OBJECTIVES: To identify predictors of poor overall survival (OS) amongst patients with penile squamous cell carcinoma (pSCC) with clinical inguinal lymphadenopathy (cN+), in order to define the best candidates for neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS: Using an international, multicentre database of 924 patients with pSCC, we identified 334 men who harboured cN+ with available clinical and follow-up data. Lymph node involvement was defined either by the presence of palpable inguinal node disease or by preoperative computed tomography (CT) assessment. Fluorine-18 fluorodeoxyglucose positron-emission tomography ((18) F-FDG-PET)/CT scan was performed based on clinical judgment of the treating physician. Regression-tree analysis generated a risk stratification tool for prediction of 24-month overall mortality (OM). Kaplan-Meier explored the OS benefit related to the use of NAC according to the regression-tree-stratified subgroups. RESULTS: Overall, 120 (35.9, 152 (45.5, and 62 (18.6 patients harboured cN1, cN2, and cN3 disease. (18) F-FDG-PET/CT was performed in 48 (14.4 patients, and 16 (4.8 had inguinal and pelvic nodal PET detection. The median OS was 107 months, with a 24-month OS of 66tree analysis (area under the curve = 70, patients with cN3 and cN2 with PET/CT-detected inguinal and pelvic nodal activity had a higher risk of 24-month OM (textgreater50. NAC was associated with improved 24-month OS rates (543 only in this subgroup of patients (P = 0.002), which was also confirmed after multivariable adjustment (hazard ratio 0.28, 95.13-0.62; P = 0.002). CONCLUSION: Patients with pSCC with cN3 or cN2 and inguinal and pelvic 18F-FDG-PET/CT scan detected disease had higher 24-month OM rates according to our regression-tree model. NAC was associated with improved OS only in these subgroups of patients. Our novel decision model may help to stratify cN+ patients, and identify those who most likely will benefit from NAC prior to radical surgical resection.
M3 - Article
JO - BJU International
JF - BJU International
SN - 1464-4096
IS - 6
ER -