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Penile cancer: studies on prognostic factors
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Örebro: Örebro university , 2014. , p. 77
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 108
Keywords [en]
Human papillomavirus, Incidence, Penile cancer, Prognostic factors, Recurrences, Sentinel node, Survival
National Category
Medical and Health Sciences Surgery
Research subject
Medicine; Surgery
Identifiers
URN: urn:nbn:se:oru:diva-35379ISBN: 978-91-7529-002-7 (print)OAI: oai:DiVA.org:oru-35379DiVA, id: diva2:725720
Public defence
2014-09-26, Universitetssjukhuset, Wilandersalen, Södra Grev Rosengatan, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2014-06-17 Created: 2014-06-17 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Human papillomavirus prevalence, distribution and correlation to histopathological parameters in a large Swedish cohort of men with penile carcinoma
Open this publication in new window or tab >>Human papillomavirus prevalence, distribution and correlation to histopathological parameters in a large Swedish cohort of men with penile carcinoma
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2011 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 108, no 3, p. 355-359Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE To analyse the overall and type-specific human papillomavirus (HPV) prevalence and distribution in penile carcinoma and determine the correlation to histopathological parameters.

PATIENTS AND METHODS In this retrospective study, we analysed HPV status in 241 patients with penile carcinoma, treated at Orebro University Hospital, Orebro, Sweden, between 1984 and 2008. Age and date at diagnosis was recorded. The tumour specimens were categorized according to the UICC 2002 TNM classification. A subset of patients was operatively staged with regard to lymph node status. A commercially available Real Time PCR was used to detect 13 different types of HPV (6,11,16,18,31,33,35,45,51,52,56,58 and 59).

RESULTS We excluded 25 patients due to low DNA quality. Of the remaining 216, 179 (82.9%) tumour specimens were HPV infected. The majority of cases positive for HPV (70.4%) were infected by a single-type. The most frequent type was HPV 16 followed by HPV 18. No significant association between HPV status and pathological tumour stage, grade or lymph node status was found.

CONCLUSION The HPV prevalence found is higher than in most other studies, further strengthening HPV as an etiological agent in penile carcinoma. Furthermore, the high prevalence of HPV 16 and 18 raises the question of what potential impact current HPV vaccines that target these specific HPV types might have on penile carcinoma. No significant association between HPV status and histopathological parameters was found in the present study. Additional investigations are needed to draw final conclusions on the prognostic value of HPV status in penile carcinoma.

National Category
Medical and Health Sciences
Research subject
Biomedicine
Identifiers
urn:nbn:se:oru:diva-18676 (URN)10.1111/j.1464-410X.2010.09770.x (DOI)000293007800013 ()21044240 (PubMedID)2-s2.0-79960606053 (Scopus ID)
Available from: 2011-09-30 Created: 2011-09-29 Last updated: 2018-05-03Bibliographically approved
2. Recurrence patterns of squamous cell carcinoma of the penis: Recommendations for follow-up based on a two-centre analysis of 700 patients
Open this publication in new window or tab >>Recurrence patterns of squamous cell carcinoma of the penis: Recommendations for follow-up based on a two-centre analysis of 700 patients
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2008 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 54, no 1, p. 161-169Article in journal (Refereed) Published
Abstract [en]

Background: Current follow-up recommendations for patients with penile carcinoma are based on small numbers of patients.

Objectives: To give further insight into the recurrence patterns of penile carcinoma in different treatment settings and provide recommendations for follow up.

Designs, Setting, and Participants: In this retrospective study, we analysed 700 patients from two referral centres for penile carcinoma for recurrences.

Measurements: Recurrences were categorized as local, regional, or distant. The rate of local recurrences was compared between patients undergoing penile-preserving treatments and partial/total amputation. Regional recurrences were compared between patients surgically staged as pN0 or pN+ and clinically node-negative (cN0) patients subjected to a wait-and-see policy. The total recurrence rate, type of recurrence, time to recurrence, and survival were calculated.

Results and Limitations: 205 out of 700 patients (29.3%) had a recurrence, consisting of 18.6% local, 9.3% regional, and 1.4% distant recurrences. Of the recurrences, 92.2% occurred within 5 yr after primary treatment. All regional and distant recurrences occurred within 50 and 16 mo, respectively. The local recurrence rate was 27.7% after penile-preserving therapy and 5.3% after amputation. The regional recurrence rate was 2.3% in patients staged as pN0, 19.1% in patients staged as pN+, and 9.1% in patients undergoing a wait-and-see policy. The 5-yr disease-specific survival was 92% after a local recurrence and 32.7% after a regional recurrence. All patients with a distant recurrence died within 22 mo. Although the number of analysed patients is substantial, the results do not necessarily reflect those of other centres using different techniques for the management of penile carcinoma.

Conclusions: Patients undergoing penile-preserving therapy, patients surgically staged as pN+, and those undergoing a wait-and-see policy for the nodal status are at high risk of developing a recurrence. Follow-up recommendations are provided based on the risk and impact on survival of a recurrence.

Keywords
follow-up recommendations, penile neoplasms, recurrence, survival
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-42992 (URN)10.1016/j.eururo.2008.04.016 (DOI)000257260400025 ()18440124 (PubMedID)2-s2.0-44149119291 (Scopus ID)
Available from: 2015-02-27 Created: 2015-02-27 Last updated: 2017-12-04Bibliographically approved
3. Dynamic sentinel node biopsy in penile cancer: initial experiences at a Swedish referral centre
Open this publication in new window or tab >>Dynamic sentinel node biopsy in penile cancer: initial experiences at a Swedish referral centre
2013 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 111, no 3B, p. E48-E53Article in journal (Refereed) Published
Abstract [en]

Study Type Therapy (case series) Level of Evidence4 What's known on the subject? and What does the study add? According to the current European Association of Urology Guidelines, dynamic sentinel node biopsy is the recommended approach to assess lymph node status in men with cN0 intermediate and high risk penile cancer. Nevertheless, most encouraging results derive from a limited number of studies. The present study shows a false-negative rate of 15%, comparable with or better than several previous studies. Nevertheless, the aim should be a false-negative rate of no more than 5%. We conclude that increased overall experience and the use of the complete modern dynamic sentinel node biopsy protocol are paramount to improve results.

OBJECTIVE center dot To evaluate the false-negative rate and complication rate of dynamic sentinel node biopsy (DSNB) in penile cancer.

PATIENTS AND METHODS center dot In this retrospective study, 58 unilaterally or bilaterally clinically lymph node negative (cN0) patients with penile cancer (57 squamous cell carcinomas and one malignant melanoma), scheduled for DSNB at the orebro University Hospital, Sweden, between 1999 and 2011, were analysed. center dot Preoperative ultrasonography and fine-needle aspiration cytology of suspicious nodes were not introduced until 2008. center dot Patients were assessed by lymphoscintigraphy using 99mtechnetium nanocolloid on the day before surgery and the dissection of sentinel nodes was aided by the lymphoscintigraphic images and intraoperative detection of radiotracer and patent blue dye. center dot The false-negative rate and complication rate were calculated per groin.

RESULTS center dot Of the 58 patients, 32 (55%) underwent preoperative ultrasonography. center dot Two patients had positive fine-needle aspiration cytology and discontinued further DSNB protocol. Of the remaining 56 patients, all but one were bilaterally cN0 and hence 111 cN0 groins were assessed by lymphoscintigraphy. center dot In the 55 bilaterally cN0 patients, lymphoscintigraphy visualized a bilateral sentinel node in 34 (62%). center dot At surgery, all excised sentinel nodes were radioactive while 43% were additionally blue. In total, at least one sentinel node was harvested in 96 (86%) of the DSNB staged groins. center dot A positive sentinel node was found in 11 groins (bilaterally in three patients). During a median follow-up of 21 months, two false-negative cases emerged, producing a false-negative rate of 15%. Both false-negative cases occurred during the first half of the study. The complication rate was 10%. The majority of complications were minor and transient.

CONCLUSIONS center dot DSNB is a minimally invasive staging tool in men with cN0 penile cancer, enabling early detection of metastatic disease and thus optimal care. center dot Our false-negative rate of 15% is comparable or even favourable in comparison with several previous studies, but far from the 5% or less that we aim for. The complication rate found is somewhat higher than previously reported. center dot With increased overall experience and the continued use of the complete DSNB protocol, we believe our results will improve and the complication rate will decrease.

Keywords
penile cancer, sentinel node, lymphoscintigraphy, false-negative rate, complications, learning curve
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-42993 (URN)10.1111/j.1464-410X.2012.11437.x (DOI)000315642700005 ()22928991 (PubMedID)2-s2.0-84874687293 (Scopus ID)
Available from: 2015-02-27 Created: 2015-02-27 Last updated: 2018-05-26Bibliographically approved
4. The swedish national penile cancer register: incidence, tumour characteristics, management and survival
Open this publication in new window or tab >>The swedish national penile cancer register: incidence, tumour characteristics, management and survival
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(English)Manuscript (preprint) (Other academic)
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-42994 (URN)
Available from: 2015-02-27 Created: 2015-02-27 Last updated: 2017-10-17Bibliographically approved

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Kirrander, Peter

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