Introduction: Different combined outcomes have been proposed to optimize results reporting after urologic cancer surgery but none for penile tumors. We proposed a Tetrafecta and assessed its ability to predict cancer-specific (CSS) and overall survival (OS) probabilities.
Methods: a purpose-built multicenter database was queried for patients with non-metastatic penile cancer (PC) who underwent total/partial penectomy ± inguinal lymph node dissection (ILND) at the 3 participating institutions from 2015 onwards. Baseline demographic, clinical, pathologic and perioperative data were collected. Tetrafecta was defined endorsing standardized and reproducible variables: negative surgical margins (NSM), no severe complications (Clavien Dindo grade =3), = 7 lymph nodes (LNs) retrieved from each treated groin (when ILND was due), no evidence of disease at 12 months (NED12mo). The study population was split according to Tetrafecta achievement: ?²- and Kruskal-Wallis tests were used to compare categorical and continuous variables. Kaplan-Meier analysis was performed to investigate the predictive role of Tetrafecta on CSS and OS.
Results: overall, 276 patients were collected but 98 were excluded from the analysis because of missing data. Out of 178 included PC-men, 42 (24%) achieved the Tetrafecta (Tab 1) (Fig 1). The 2 groups showed comparable baseline characteristics (all p>0.05). On Kaplan-Meier analysis, the Tetrafecta cohort displayed significantly higher CSS (p=0.009) and OS (p=0.014) probabilities (Fig 2).
Conclusions: our Tetrafecta is the first combined outcome to comprehensively report perioperative outcomes after surgery for PC. It is widely applicable, based on standardized and reproducible variables and it predicts cancer-specific and all-cause mortality.