Prognostic risk stratification derived from individual patient level data for men with advanced penile squamous cell carcinoma receiving first-line systemic therapy

Gregory R. Pond, Giuseppe Di Lorenzo, Andrea Necchi, Bernhard J. Eigl, Michael P. Kolinsky, Raju T. Chacko, Tanya B. Dorff, Lauren C. Harshman, Matthew I. Milowsky, Richard J. Lee, Matthew D. Galsky, Piera Federico, Graeme Bolger, Mollie DeShazo, Amitkumar Mehta, Jatinder Goyal, Guru Sonpavde

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Background: Prognostic factors in men with penile squamous cell carcinoma (PSCC) receiving systemic therapy are unknown. A prognostic classification system in this disease may facilitate interpretation of outcomes and guide rational drug development. We performed a retrospective analysis to identify prognostic factors in men with PSCC receiving first-line systemic therapy for advanced disease. Patients and methods: Individual patient level data were obtained from 13 institutions to study prognostic factors in the context of first-line systemic therapy for advanced PSCC. Cox proportional hazards regression analysis was conducted to examine the prognostic effect of these candidate factors on progression-free survival (PFS) and overall survival (OS): age, stage, hemoglobin, neutrophil count, lymphocyte count, albumin, site of metastasis (visceral or nonvisceral), smoking, circumcision, regimen, ECOG performance status (PS), lymphovascular invasion, precancerous lesion, and surgery following chemotherapy. The effect of different treatments was then evaluated adjusting for factors in the prognostic model. Results: The study included 140 eligible men. Mean age across all men was 57.0 years. Among them, 8.6%, 21.4%, and 70.0% of patients had stage 2, 3, and 4 diseases, respectively; 40.7% had ECOG PS≥1, 47.4% had visceral metastases, and 73.6% received cisplatin-based chemotherapy. The multivariate model of poor prognostic factors included visceral metastases (P<0.001) and ECOG PS≥1 (P<0.001) for both PFS and OS. A risk stratification model constructed with 0, 1, and both poor prognostic factors was internally validated and demonstrated moderate discriminatory ability (c-statistic of 0.657 and 0.677 for OS and PFS, respectively). The median OS for the entire population was 9 months. Median OS was not reached, 8, and 7 months for those with 0, 1, and both risk factors, respectively. Cisplatin-based regimens were associated with better OS (P = 0.017) but not PFS (P = 0.37) compared with noncisplatin-based regimens after adjusting for the 2 prognostic factors. Conclusions: In men with advanced PSCC receiving first-line systemic therapy, visceral metastases and ECOG PS≥1 were poor prognostic factors. A prognostic model including these factors exhibited moderate discriminatory ability for outcomes and warrants external validation. Patients receiving cisplatin-based regimens exhibited better outcomes compared with noncisplatin-based regimens after adjusting for prognostic factors.

Original languageEnglish
Pages (from-to)501-508
Number of pages8
JournalUrologic Oncology: Seminars and Original Investigations
Volume32
Issue number4
DOIs
StatePublished - May 2014
Externally publishedYes

Keywords

  • Advanced
  • Penile squamous cell carcinoma
  • Prognosis
  • Systemic therapy

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