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Patterns of Treatment and Outcomes in Older Men With Penile Cancer: A SEER Dataset Analysis. | LitMetric

AI Article Synopsis

  • The study aims to review the characteristics and treatment approaches for penile cancer, particularly in older adults, given that there is limited guidance for this age group.
  • Analyzed data from 3,784 patients showed that a majority (58.7%) were aged 65 or older; these older patients received less aggressive treatments and had a median overall survival of 49 months compared to younger patients whose survival data was inconclusive.
  • Findings suggest that older patients face a higher risk of dying from other causes, while younger patients have a higher mortality from penile cancer itself, highlighting the need for improved treatment strategies for older adults.

Article Abstract

Purpose: To evaluate clinicopathologic and treatment characteristics from a population-based cohort of penile cancer, with an emphasis in older adults, due to incomplete evidence to guide therapy in this age subgroup.

Materials And Methods: Patients with malignant penile tumors diagnosed 2004-2016 were identified in the Surveillance, Epidemiology and End Results Program (SEER)-18 dataset. Demographic and treatment characteristics were obtained. Population was analyzed by age at diagnosis (<65 vs ≥65 years). We examined univariate associations between age groups with Chi-square analysis. To study survival, we calculated Kaplan-Meier survival curves, but due to the high number of competing events, we also performed a univariate competing risk analysis using the cumulative incidence function, and a multivariate analysis using the Fine-Gray method. We also described competing mortality due to penile cancer and other causes of death.

Results: We included 3,784 patients. Median age was 68 years, 58.7% were aged ≥65. Older patients were less likely to have received chemotherapy (p<0.001), primary site surgery (p = 0.002), or therapeutic regional surgery (p <0.001). Median overall survival (OS) in patients <65 years was not reached (95% CI incalculable) vs 49 months in those ≥65 years (95% CI 45-53, p <0.0001). On univariate analysis, age was associated with a lower incidence of penile cancer death. On multivariate analysis, stage at diagnosis, and receipt of primary site surgery were associated with a higher incidence of penile cancer death. Estimated penile cancer-specific mortality was higher in patients <65 years in stages II-IV. Estimated mortality due to other causes was higher in older patients across all stages.

Conclusions: Older patients are less likely to receive surgery, chemotherapy and radiotherapy for penile cancer. Primary surgical resection was associated with better penile cancer-specific mortality on multivariate analysis. Competing mortality risks are highly relevant when considering OS in older adults with penile cancer. Factors associated with undertreatment of older patients with penile cancer need to be studied, in order to develop treatment strategies tailored for this population.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9277543PMC
http://dx.doi.org/10.3389/fonc.2022.926692DOI Listing

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