Presentation Authors: Michelle Christodoulidou*, Ramachandran Navin, LONDON, United Kingdom, Burden Sorrel, Debra Gibson, Simon Lal, Manchester, United Kingdom, Toby Richards, Asif Muneer, LONDON, United Kingdom
Introduction: There is limited evidence on how frailty affects the prognosis and survival of patients diagnosed with penile cancer. In a previous case-controlled study by our group we found that sarcopenia was significantly associated with higher mortality and shorter cancer-specific survival in patients with metastatic penile cancer (n=50) but not in those with non-metastatic disease (n=50). The objective of this study was to perform a larger scale analysis to re-assess how body composition parameters affect the prognosis in patients with non-metastatic penile cancer.
Methods: We performed a retrospective cohort study in patients diagnosed and treated for penile cancer in our institution without any evidence of metastatic disease following a minimum of 3 years surveillance. The variables assessed were: primary tumour indicators (tumour grade-stage-subtype, lymphovascular/perineural invasion, Carcinoma in situ), Charlson co-morbidity index, perioperative complications, length of hospital stay and body composition parameters such as sarcopenia (Skeletal Muscle Index < 55cm2/m2), body mass index (BMI) as well as visceral obesity. CT-derived body composition assessment was done using preoperative imaging and SliceOmatic software.
Results: We identified 193 patients on our dataset diagnosed and treated for non-metastatic penile cancer in our unit from 2006 to 2015. Median age in our study was 65 (range 28-89). Thirty-one (16%) patients died during follow-up, 74% due to pre-existing medical conditions and 26% due to a second cancer. Following univariable analysis, the following factors were found to be associated with mortality: age, tumour grade (G2-3,G3), second primary cancer, diabetes mellitus, cardiovascular disease, Charlson co-morbidity index and post-operative systemic complications (all p < 0.05). No associations were found between mortality and other primary tumour factors, length of hospital stay and BMI. Sarcopenia with a BMI < 20 and visceral obesity were associated with mortality (p < 0.05) and following multivariable analysis, these two markers and the presence of a second primary cancer and post-operative systemic complications remained associated with a higher mortality rate.
Conclusions: CT-derived body composition parameters remain a reproducible and accurate way of interpreting muscle and fat mass in patients at the time of diagnosis. Larger cohort studies are required to further assess the impact of sarcopenia and visceral obesity as prognostic markers in this group of patients and to test their validity in a prognostic scoring model.