Predicting Limited Survival Following Inguinal Lymph Node Dissection in Penile Cancer: Should we revisit the goals of care?

Overview

OBJECTIVE: Patients with advanced penile squamous cell cancer (pSCC) have a poor prognosis and can benefit from early palliative care consultation. We built a model to identify those patients most likely to benefit. METHODS: Patients with pSCC undergoing inguinal lymph node dissection (ILND) were identified from the National Cancer Database (NCDB) and a multi-institutional international dataset (INT). A multivariable Cox proportional hazards model for OS was developed using the NCDB and applied to the INT dataset. Parameters were used to make ROC curves. ROC-related criteria were optimized to identify a predictive probability cut point and dichotomize patients from INT into risk groups for limited OS of <6 and <12 months. RESULTS: NCDB had 860 deaths; 105 (5%) at 6 months and 296 (15%) at 12 months. INT had 257 deaths; 56 (8%) at 6 months and 124 (18%) at 12 months. Limited OS was associated with older age, greater T and N stage, and fewer lymph nodes removed. Optimized ROC criteria using the OS <6 month curve best dichotomized INT patients into high risk group with median OS of 24 months (95% CI 18-34) and low risk group with median OS of 174 months (95% CI 120-NE. CONCLUSION: We developed a simple model that could be used as a screening tool for early palliative care referral.