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Demographic and socioeconomic predictors of treatment delays, pathologic stage, and survival among patients with penile cancer: A report from the National Cancer Database

Urologic Oncology: Seminars and Original Investigations Oct 26, 2017

Attalla K, et al. - An exploratory analysis was performed of the potential impact of socioeconomic factors on the pathologic stage, treatment delays, pathologic upstaging, and overall survival (OS) in patients with penile cancer (PC). The poor prognostic factors were unveiled to be as follows: Socioeconomic variables, no insurance, lower education, race, Hispanic ethnicity, and nonmetropolitan residence. A rise in the educational awareness of this rare disease could assist in reducing the delays in diagnosis, improve prognosis thereby ultimately prevented deaths among socioeconomically disadvantaged men with PC.

Methods

  • The enrollees consisted of 13,283 patients diagnosed with PC from 1998 to 2012, selected from the National Cancer Database.
  • Socioeconomic, demographic and pathologic variables used in multivariable regression models, assisted in determining the predictors of pathologic T stage ≥2, pathologic lymph node positivity, cT to pT upstaging, treatment delays, and OS.

Results

  • It was reported that a 5-year OS was 61.5% with a median follow-up of 41.7 months.
  • Pathologic T stage ≥2 was detected in 3,521 patients (27.2%), 1,173 (9.2%) presented with ≥pN1 and 388 (7.9%) experienced cT to pT upstaging.
  • Variables realted to a higher tendency of pathologic T stage ≥2 consisted of no insurance (OR=1.79, P<0.001), lower higher education based on zip code (OR=1.13, P=0.027), black race (OR=1.17, P=0.046) and Hispanic ethnicity (OR=1.66, P<0.001).
  • Patients with Hispanic ethnicity (OR=1.46; P<0.001) or living in nonmetropolitan areas exhibited an increased tendency of having ≥pN1 (P=0.001).
  • A correlation was illustrated between the lack of insurance with cT to pT upstaging (OR=2.05, P=0.001) as was living in an urban vs. metropolitan area (OR=1.35, P=0.031).
  • Alongside the TNM stage, black vs. white race (HR=1.56, P<0.001), living in an urban vs. metropolitan area (hazard ratio [HR] = 1.18, P=0.022), age (HR=1.04, P<0.001) and Charlson score (HR=1.49, P<0.001) were related to lower OS.

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