Survival benefit and utilization disparities of lymph node dissection in clinically node-negative T2+ penile squamous cell carcinoma: A SEER database analysis.

Authors

Hangcheng Fu, Abigail George, Uzoma Anele, Mohammed Said, Jamie Messer, Murali K Ankem

Published in

Canadian Urological Association journal = Journal de l'Association des urologues du Canada. Jul 20, 2026. Epub Jul 20, 2026.

Abstract

Penile squamous cell carcinoma (PSCC), although rare, presents significant morbidity. Current guidelines recommend lymph node dissection (LND) or lymph node biopsy on a risk-stratified basis for intermediate- or high-risk patients; however, survival benefits of LND in clinically node-negative patients need further exploration.
Patients with T2+N0M0 PSCC were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). Inclusion required histologically confirmed squamous cell carcinoma localized to the penis. Patients with unavailable staging or unknown followup were excluded. Chi-square tests, Kaplan-Meier survival curves, and multivariable Cox regression analyses assessed disease-specific survival (DSS).
A total of 825 patients were analyzed. The cohort predominantly included non-Hispanic White (65.2%) and Hispanic (22.3%) patients, with a median age of 69 years. Most patients were married (57.2%), while few received radiation (6.6%) or chemotherapy (3.5%). Only 23.5% underwent LND, with no significant variation across T stages. Median followup was 60 months. Chemotherapy usage increased significantly with advancing T stage (p=0.009), whereas radiation did not. LND significantly improved DSS overall (p<0.001) and specifically in T2 (p=0.040) and T3 stages (p=0.002). Multivariable analysis identified LND as an independent protective factor (hazard ratio [HR] 0.457, 95% confidence interval [CI] 0.328-0.711, p<0.001). Younger patients (<40 years) had higher LND rates (56%) compared to older patients (>70 years; 14.8%).
Despite NCCN guidelines recommending LND for T2N0M0 PSCC, utilization remains low. Our findings highlight a survival advantage associated with regional LND, underscoring the need for enhanced urologist education to improve adherence and patient outcomes.

PMID:
42531447
Bibliographic data and abstract were imported from PubMed on 31 Jul 2026.

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