Characterization, treatment and survival outcomes of penile cancer: Over a decade in a tertiary Mexican center.

Abstract

5 Background: Penile cancer, as a rare disease worldwide, represents 4.1% of urological cancers in Mexico. Despite the need for multimodal treatments, delayed diagnoses and poor follow-up adherence impact survival outcomes. This study aims to characterize the patient population diagnosed with penile cancer at a tertiary center in Mexico and evaluate treatment and survival outcomes. Methods: This cross-sectional retrospective cohort study analyzed patients diagnosed with penile cancer at the medical oncology and urology services of Centro Médico Nacional 20 de Noviembre from January 2005 to January 2024. Statistical analyses included Kaplan-Meier survival analysis and subgroup analyses by age, surgical treatment type and radiotherapy. Results: Of the 54 patients analyzed, the median age was 64 years (34-84) with a median time symptoms to diagnosis of 12 months. Clinical stages at diagnosis were stage I (9.2%), II (40.7%), III (29.6%) and IV (20.3%). Human papillomavirus (HPV) was positive in 17 patients (31.4%), negative in 2 (3.7%) and undetermined in 35 (64.8%). HIV status was undetermined in 88.8% of cases. Additionally, 22 patients (40.7%) were smokers. Tumor anatomical locations were glans (64.8%), prepuce (25.9%), body of the penis (7.4%) and scrotum (1.8%). Histologically, all cases were squamous cell carcinoma. Most common sites of metastasis were lymph nodes (79.6%), lungs (7.4%) and liver (5.5%). Systemic therapy was administered to 38.8% and radiotherapy to 55.5% with a median overall survival of 44.8 months. Surgical treatment was required in most cases (88.8%), with total penectomy and bilateral inguinal dissection predominating in 21 patients (38.9%), followed by total penectomy alone in 8 (14.8%), partial penectomy with bilateral inguinal dissection in 6 (11.1%) and partial penectomy in 8 (14.8%). Tumor resection alone was performed in 5 (9%). Subgroup analysis based on age, surgical technique and radiotherapy indicated that overall survival was not significantly affected by age when comparing patients <60 years to those >60 years (p=0.1). However, patients undergoing partial penectomy had significantly higher survival rates (12 months vs 7 months; p=0.04), regardless of clinical stage. There was no significant difference in overall survival between patients who received radiotherapy and those who did not (p=0.7). Conclusions: Despite advanced stage at diagnosis, the results suggest that surgical intervention is associated with improved survival rates. However, neither age nor radiotherapy significantly impacted overall survival outcomes, likely due to the homogeneity of clinical stages and surgical approaches. These findings underscore the importance of early detection and comprehensive management strategies to improve survival in this patients.