Joshi SS, et al. - The National Comprehensive Cancer Network (NCCN) guidelines advocate a lymph node dissection (LND) or radiotherapy with consideration of perioperative chemotherapy for all patients with lymph node–positive (LN+) penile cancer without metastasis. It was demonstrated in this current study that an LND was performed on only 66.8% of patients with LN+ penile cancer in hospitals reporting to the National Cancer Database (NCDB). Since 2004, an increase has been reported in the use of chemotherapy while rates remained low (52.8% for patients with N3 cancer). Notably, receipt of LND, but not chemotherapy or radiotherapy, was found to be associated with overall survival.

• Researchers searched the US National Cancer Database (NCDB) for all 1123 patients with LN+, squamous cell carcinoma of the penis without metastasis from January 1, 2004, through December 31, 2014.
• They used Cochran-Armitage tests to assess temporal trends.
• They used multivariable logistic models to examine the link between treatments, clinicopathologic variables, and receipt of chemotherapy.
• Using Kaplan-Meier analyses with log-rank tests and multivariable Cox regressions, they analyzed overall survival.
• Data analysis was carried out between January 2017 and September 2017.
• They assessed use of chemotherapy over time and survival outcomes by receipt or nonreceipt of LND, radiotherapy, and chemotherapy.

• Researchers identified a total of 1123 patients; most were white (924 [82.3%]) vs African American (141 [12.6%]) or of other or unknown race (58 [5.2%]).
• Data showed that most patients (727 [64.7%]) were between 50 and 75 years of age, and 750 patients (66.8%) underwent an LND.
• A significant increase was noted in the use of systemic therapy from 2004 to 2014 (26 of 68 patients, 38.2% vs 65 of 136, 47.8%; P < .001).
• However, receipt of chemotherapy was reported in only 177 of 335 patients with N3 disease (52.8%) (N1: 106 of 338, 31.4%; N2: 178 of 450, 39.6%).
• It was noted that after adjustment, older patients (>76 years: OR, 0.28; 95% CI, 0.15-0.50; P < .001) were less likely to receive chemotherapy.
• The chances of receiving chemotherapy were more in patients who received radiotherapy (OR, 4.38; 95% CI, 3.10-6.18; P < .001) and in those with N2 (OR, 1.62; 95% CI, 1.16-2.27; P=.005) or N3 (OR, 2.32; 95% CI, 1.67-3.22; P < .001) cancer.
• On multivariable analysis, researchers found that LND (HR, 0.64; 95% CI, 0.52-0.78; P < .001) was related to better overall survival, while neither chemotherapy (HR, 1.01; 95% CI, 0.80-1.26; P=.95) nor radiotherapy (HR, 0.85; 95% CI, 0.70-1.04; P=.11) was associated with overall survival.