Urologic oncology · 2025
Organ preservation and oncological efficacy of peniscopically controlled CO2 laser excision of penile squamous cell carcinoma: Early and late results in a high-volume center.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Nazzani Sebastiano, Lorusso Vito, Catanzaro Mario, Torelli Tullio, Silvani Carlo, Macchi Alberto, Biasoni Davide, Darisi Ruggero, Colbacchini Claudia, Stagni Silvia, Tesone Antonio, Claps Melanie, Giannatempo Patrizia, Zimatore Matteo, Cattaneo Laura, Montanari Emanuele, Nicolai Nicola
Аннотация
OBJECTIVES: To evaluate safety and early and long-term efficacy of CO2 laser conservative treatments for nonulcerative squamous cell carcinoma (SCC) of the penis.
MATERIAL AND METHODS: Within our institutional database (2002-2022, included), we identified 122 consecutive cT1-2 cN0 cM0 patients with penile SCC who underwent conservative CO2 laser treatments. Histologically confirmed local relapses were recorded. Local relapses were classified as early recurrences when occurring <2 years and as late new tumor recurrences when occurring >2 years after first laser treatment. Predictors of disease relapse were analyzed with univariable and multivariable Cox regression models (MCRMs).
RESULTS: Median follow-up was 36 months [Interquartile range (IQR) 21-73 months]. Median age was 62 years (IQR: 51-69 years). Median largest lesion size was 10 mm (IQR 5-15 mm). 62 patients had penile intraepithelial neoplasia (PeIN) (51.6%), 30 had pT1 m (24.6%), 28 had pT1 (23%) and 1 had pT2 (0.8%), 2 patients were classified as pTx. In case of invasive lesions, tumor Grade was G1 in 37 (60.7%), G2 in 20 (32.8%), G3 in 4 (6.5%). Early and late recurrences occurred in 28 (22%) and in 21 patients (18%), respectively. Proportion of penis preservation was 93.4% and 92.6% at 2 and 5 years. pT1 stage [Hazard Ratio (HR) 13, Confidence Interval (CI) 1.4-73, p-value 0.02] and flat lesions (HR 7.9, CI 1.06-59, 0.04) achieved independent predictor status for late recurrences. No cancer related deaths were recorded after a median follow-up of 36 months.
CONCLUSIONS: As far as we know, this is the largest cohort of patients with penile cT1-T2 SCC who underwent conservative CO2 laser treatment. The vast majority (92%) of these patients preserved their organ at 5 years. Some factors can be of use in preventing or anticipating late recurrences.
MATERIAL AND METHODS: Within our institutional database (2002-2022, included), we identified 122 consecutive cT1-2 cN0 cM0 patients with penile SCC who underwent conservative CO2 laser treatments. Histologically confirmed local relapses were recorded. Local relapses were classified as early recurrences when occurring <2 years and as late new tumor recurrences when occurring >2 years after first laser treatment. Predictors of disease relapse were analyzed with univariable and multivariable Cox regression models (MCRMs).
RESULTS: Median follow-up was 36 months [Interquartile range (IQR) 21-73 months]. Median age was 62 years (IQR: 51-69 years). Median largest lesion size was 10 mm (IQR 5-15 mm). 62 patients had penile intraepithelial neoplasia (PeIN) (51.6%), 30 had pT1 m (24.6%), 28 had pT1 (23%) and 1 had pT2 (0.8%), 2 patients were classified as pTx. In case of invasive lesions, tumor Grade was G1 in 37 (60.7%), G2 in 20 (32.8%), G3 in 4 (6.5%). Early and late recurrences occurred in 28 (22%) and in 21 patients (18%), respectively. Proportion of penis preservation was 93.4% and 92.6% at 2 and 5 years. pT1 stage [Hazard Ratio (HR) 13, Confidence Interval (CI) 1.4-73, p-value 0.02] and flat lesions (HR 7.9, CI 1.06-59, 0.04) achieved independent predictor status for late recurrences. No cancer related deaths were recorded after a median follow-up of 36 months.
CONCLUSIONS: As far as we know, this is the largest cohort of patients with penile cT1-T2 SCC who underwent conservative CO2 laser treatment. The vast majority (92%) of these patients preserved their organ at 5 years. Some factors can be of use in preventing or anticipating late recurrences.