Presentation Authors: Louise English, Mehran Afshar, Lisa Pickering, Alison Tree, Benjamin Ayres, Nick Watkin, London, United Kingdom
Introduction: Penile cancer incidence increases with age, most commonly being diagnosed in men over the age of 60 years. There is little evidence on the independent risk of age and prognosis. However, there is a non-validated commonly held presumption that younger patients have a more aggressive phenotype with a higher risk of progression and death.
Methods: A prospectively collected database of patients with penile cancer between 2002 and 2017 referred to our supra-regional centre was interrogated. Patients were split into 3 age groups based on the median age; Group1, < 55 years old, Group2,55-74 years old, Group3 >74 years. These age groups are in line with other published age related oncological studies. Survival time was calculated from the date of referral/index surgery(whichever was sooner), until the date of death. Penile cancer specific mortality was calculated. To look for potential confounders we analysed T-stage, grade and lymph node status. Hazard ratios (HR) for death in the different age groups were corrected for these 3 variables. The Kaplan Meier method was used to analyse survival, and Cox regression tables were used to analyse HR for death. Patients were followed up for a maximum of 10 years.
Results: 900 patients with complete data were included in the study. The median age was 63 years (IQR 52-73). 270 patients were in Group 1, 438 patients in Group 2, and 192 patients in Group 3.Kaplan-Meier curves shows a clear disparity in survival rates (Log Rank p < 0.027). A greater proportion of patients in the older age groups had higher stage and grade of disease and N2/N3 disease. When corrected for confounders, the hazard ratio for death between the age groups reduced to 1.44 (95% CI 1.14-1.93) (p=0.03). This suggests that although the 3 confounders tested do influence the finding of age as a prognostic marker, there is still a significant higher risk of penile cancer specific death in the older age groups, when corrected for the 3 confounders.
Conclusions: This study shows that penile cancer specific survival outcomes are incrementally worse with each increasing age group. Patients are more likely to have nodal involvement, higher stage and grade of tumour but additional factor(s) are involved to account for the difference. It is possible that with increasing age and co-morbidity, patients had less access to radical and adjuvant treatment.