Abstract C127: Delays in penile cancer presentation and undertreatment may drive higher penile cancer mortality in Latinos and older men in California
Authors: Nabhani Jamal , Baccaglini Willy , Medina Luis , Sotelo Rene , Liu Lihua , Deapen Dennis , Stern Mariana C. 
Published: August 2020

Abstract
Background: Penile cancer, although relatively rare, has a 5-year survival rate of approximately 50% and carries a considerable physical and psychological burden due to penile resections needed for its treatment at more advanced stages. We evaluated the racial/ethnic, sociodemographic, and corresponding clinical and treatment patterns among men diagnosed with penile cancer in California.
Methods: We used data from the California Cancer Registry between 1998-2012. We performed logistic regression to evaluate the likelihood of presenting with a high-risk primary tumor (pathologic tumor stage 2 or greater), receipt of radical surgery (partial or radical penectomy controlling for cancer stage), and receipt of chemotherapy (controlling for cancer stage). Finally, we performed a survival analysis using a cox proportional-hazard model controlling for sociodemographic and clinical features.
Results: We included 3,201 cases of penile cancer. Of those, 2,107 (65.8%) were non-Latino White (NLW), 731 (22.8%) were Latinos, 160 (5%) were non-Latino Black (NLB), and 203 (6.34%) were Asian Pacific Islanders (API). Age-adjusted incidence rates were 1.29 for NLW, 1.25 for NLB, 1.45 for Latinos, and 0.67 for API. In the high-risk tumor analysis, Latinos were two times more likely to present with locally advanced disease in comparison with NLW (OR 2.04, 1.46-2.86, p&lt;0.001). Additionally, Medicaid insurance (OR 2.1, 1.23-3.59, p=0.006) and low socioeconomic status (OR 1.52, 1.10-2.11, p=0.01) were independently associated with presentation with a high-risk tumor. Receipt of radical surgery was associated with higher cancer stage (OR 7.07, 4.28-11.67, p&lt;0.0001) and more proximal tumor location (OR 2.02, 1.02-4.36, p=0.044). Age greater than 75 years was associated with a lower likelihood of receiving radical surgery (OR 0.63, 0.41-0.98, p=0.039) relative to men &lt;50 years. Patients presenting with positive lymph nodes and distant metastases were more likely to receive chemotherapy (OR 5.73 3.73-8.79, p&lt;0.0001 and OR 15.93, 9.81-25.87, p&lt;.0001, respectively), while patients older than 75 were less likely to receive chemotherapy (OR 0.45, 0.29-0.69, p&lt;0.0001). No racial disparities were observed in receipt of surgical or systemic treatment. There were 330 penile cancer deaths in this period. In the survival analysis, when adjusting for socioeconomic status, cancer stage, and receipt of surgery, Latino men (HR 1.43, 1.08-1.87, p=0.013), men older than 75 (HR 1.75, 1.25-2.44, p&lt;0.001), and men with Medicaid insurance (HR 1.58, 1.07-2.33, p=0.02) experienced higher penile cancer mortality.
Conclusions: Increased penile cancer mortality among Latino men and men with Medicaid appears to be related to presentation with higher-risk tumors, while higher mortality among older men could be related to undertreatment. Understanding and addressing the mechanisms underlying each of these findings may help decrease the morbidity and mortality of penile cancer in California.
Citation Format: Jamal Nabhani, Willy Baccaglini, Luis Medina, Rene Sotelo, Lihua Liu, Dennis Deapen, Mariana C. Stern. Delays in penile cancer presentation and undertreatment may drive higher penile cancer mortality in Latinos and older men in California [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C127.