Nationwide Data Support Centralised Decision-making in Penile Cancer Care: A Before-and-After Study on Guideline Adherence and Disease-specific survival for Patients with an Indication for Perioperative Oncological Treatment

Background: The benefit of perioperative oncological treatment in men with penile cancer is uncertain. In 2015, treatment recommendations were centralised in Sweden and treatment guidelines were updated.Objective: To evaluate if the use of oncological treatment in men with penile cancer increased after the introduction of centralised recommendations, and whether such therapy is associated with better survival.Design, setting, and participants: This was a retrospective cohort study including a total of 426 men diagnosed with penile cancer with lymph node or distant metas-tases in Sweden during 2000-2018. Outcome measurements and statistical analysis: We first assessed the change in the proportion of patients with an indication for perioperative oncological treatment who actually received such treatment. Second, we used Cox regression to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-specific mortality associated with perioperative treatment. Comparisons were made for both all men without perioperative treatment and for those who did not receive treatment but who lacked apparent contraindications for treatment.Results and limitations: The use of perioperative oncological treatment increased from 2000 to 2018, from 32% of patients with an indication for treatment during the first 4 yr to 63% during the last 4 yr. In comparison to patients potentially eli-gible for oncological treatment who did not receive it, those who were treated had a 37% lower risk of disease-specific death (HR 0.63, 95% CI 0.40-0.98). Stage migra-tion because of improvements in diagnostic tools over time may have inflated the more recent survival estimates. An influence of residual confounding due to comor-bidity and other potential confounders cannot be excluded.Conclusions: The use of perioperative oncological treatment increased after the cen-tralisation of penile cancer care in Sweden. Although the observational study design precludes causal inference, the findings suggest that perioperative treat-ment in patients with penile cancer eligible for treatment may be associated with better survival.Patient summary: In this study, we looked at the use of chemotherapy and radio-therapy for men with penile cancer and lymph node metastases in Sweden during 2000-2018. We found an increase in the use of cancer therapy and an increase in survival for patients who received such therapy.& COPY; 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Automated summary

The benefit of perioperative oncological treatment in men with penile cancer is uncertain. However, after the introduction of centralised recommendations in Sweden and an increase in the use of such treatment, there appears to be an association with better survival for eligible patients.