Christodoulidou, Michelle;
(2023)
Developing novel prognostic indicators for the management of metastatic penile cancer.
Doctoral thesis (M.D(Res)), UCL (University College London).
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Abstract
Introduction Penile cancer is a rare cancer in Western Europe with an incidence of approximately 1 in 100,000 men. The prognosis of this disease is dictated by the presence of metastasis in the inguinal lymph nodes - currently the only reliable prognostic indicator. Sarcopenia is a novel frailty marker and is associated with poorer outcomes in oncology patients. There is limited evidence in the literature investigating the association between sarcopenia and penile cancer prognosis. The primary outcome of this thesis was to develop novel prognostic indicators for the management of metastatic penile cancer by utilising body composition parameters. Materials and Methods Two studies were conducted, retrospective, non-interventional, a case-controlled and cohort study, following the construction of a comprehensive institutional database including patients between 2005-2016. Body composition analysis was performed from available cross-sectional imaging at diagnosis. The cohorts were divided into those with and without metastatic disease and subsequently explored with univariate and multivariate analysis. Following a Cox-regression analysis of the complete cohort to assess survival, a prognostic model was created which was demonstrated with a nomogram using specialised statistical software. Results Following the case-control study analysis of patients with metastatic and non-metastatic penile cancer (n=100), I identified that sarcopenia significantly reduced overall survival (OS) in those with metastatic disease. A larger cohort analysis [n=338,Metastatic(114)-Non-Metastatic(193)-pN1-N2(31)] identified that sarcopenia reduced OS irrespective of the presence of metastatic disease. We finally produced a penile cancer prognosis nomogram predicting 2-year OS incorporating Sarcopenia(TMA), Charlson Comorbidity Index, Lymph node involvement, Distant metastases and Sarcomatoid SCC subtype as variables. Conclusion Although further validation of this frailty marker is advisable, sarcopenia has proven in this thesis, that it can be used as a prognostic indicator on its own as well as in a predictive Nomogram to risk-stratify patients with penile cancer at the time of their diagnosis.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D(Res) |
| Title: | Developing novel prognostic indicators for the management of metastatic penile cancer |
| Language: | English |
| Additional information: | Copyright © The Author [year]. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10169098 |
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