Search Results (481)

Background/Objectives: The presence of distant metastases is the main cause of death in medullary thyroid carcinoma (MTC). However, due to the rarity of this cancer, few studies have thoroughly analyzed the variables influencing the development of distant metastases. The objective of this study was to evaluate, in patients with MTC, the factors associated with the occurrence of synchronous and metachronous distant metastases. Methods: An analytical, observational, retrospective cohort study was conducted at a tertiary hospital. Patients with histologically confirmed MTC, both sporadic and familial (MEN2 syndrome), were included. The influence of epidemiological variables, heredity, complementary tests, surgical factors, histological features, staging, and disease progression was assessed. A univariate comparative analysis was first performed, followed by a multivariate analysis using logistic regression. Results: This study included 146 patients, of whom 75% (n = 109) had familial MTC. Lymph node involvement at diagnosis was observed in 36% (n = 52). During follow-up, distant metastases developed in 14% (n = 21) of patients, including five cases present at the time of diagnosis. The median follow-up was 214 months (IQR 106–289). The presence of distant metastases was associated with an increased risk of mortality. Factors associated with distant metastases included age, calcitonin level, hereditary status, lymph node involvement, and overall stage. In multivariate analysis, the lymph node ratio (LNR) remained the only significant predictor (OR 29.124). Conclusions: Several variables were related to the presence of distant metastases. Among them, the LNR emerged as the independent predictor of both synchronous and metachronous distant metastases. Full article

Background/Objectives: The global incidence of thyroid cancer has been increasing, necessitating improved diagnostic strategies for detecting lymph node metastases. Fine-Needle Aspiration Biopsy (FNA) is a widely used diagnostic tool; however, its accuracy is sometimes limited, particularly in cases with non-diagnostic results. Washout Thyroglobulin (Washout Tg) measurement has emerged as an important adjunctive tool in refining thyroid cancer diagnosis. Methods: This retrospective study analyzed 723 patients who underwent thyroid cancer surgery at Samsung Medical Center from 2013 to 2023. The patients were categorized based on their thyroid status into three groups: 1. total thyroidectomy with modified radical neck dissection (mRND); 2. completion thyroidectomy with mRND; and 3. mRND or selective neck dissection (SND) without thyroidectomy. The Washout Tg levels and their diagnostic performance were evaluated using Receiver Operating Characteristic (ROC) analysis, determining the optimal cutoff values for predicting lymph node metastasis. Results: Washout Tg demonstrated high sensitivity for detecting metastases, with the optimal cutoff values varying based on thyroid status. For the patients who had total thyroidectomy, the cutoff was 23.3 ng/mL (AUC = 0.85, sensitivity = 82.6%, and specificity = 75.0%). In completion thyroidectomy cases, a threshold of 7.2 ng/mL (AUC = 0.879) achieved 98.4% sensitivity and 80.0% specificity. For patients without thyroidectomy (mRND/SND group), a cutoff of 0.1 ng/mL (AUC = 0.766) yielded 98.9% sensitivity but lower specificity (60.0%). Additionally, the Washout Tg/serum Tg ratio demonstrated high diagnostic accuracy with a cutoff of >1 (sensitivity = 97.09% and specificity = 63.64%). Conclusions: The Washout Tg measurement and the Washout Tg/serum Tg ratio play a crucial role in detecting lymph node metastases, particularly in patients post-thyroidectomy. The findings emphasize the necessity of adjusting the Washout Tg cutoff values based on thyroid status to enhance diagnostic accuracy. Further prospective studies are required to validate these thresholds and optimize their clinical application. Full article

Background/Objectives: Older adults with gastric cancer often have poorer prognoses than younger patients. Early recurrence, within two years after curative surgery, is associated with poor outcomes, but its risk factors remain unclear. This study aimed to identify clinicopathological predictors of early recurrence in older patients with stage II/III disease. Methods: We retrospectively reviewed 604 patients with stage II/III gastric cancer who underwent curative surgery from 2009 to 2020. After exclusions, 237 patients aged ≥65 years were analyzed. Clinicopathological variables were compared between those with and without early recurrence, and risk factors were assessed using logistic regression. Results: Among the 237 patients studied, 103 had recurrence following surgery, of whom 72 (69.9%) were categorized as early recurrence. Distant metastasis was the most common pattern (59.7%), followed by peritoneal (45.8%) and locoregional (33.3%) recurrences. Multivariate analysis identified a lymph node ratio (LNR) > 0.17 as an independent risk factor for early recurrence (odds ratio (OR), 5.30; 95% confidence interval (CI), 2.07–13.53; p < 0.001). Conclusions: Early recurrence is frequent among older patients with stage II/III gastric cancer, with distant metastasis as the predominant pattern. An LNR > 0.17 predicts higher recurrence risk. While adjuvant chemotherapy showed a trend toward reduced risk, statistical significance was not reached. Further prospective studies are necessary to confirm these findings. Full article

Background: Cervical lymph node metastases are a major prognostic factor in patients with oral squamous cell carcinoma (OSCC). Despite advances in imaging, accurate preoperative prediction of nodal involvement remains a challenge. This study evaluated the utility of Isotope Ratio Mass Spectrometry (IRMS) in assessing the risk of lymph node metastases in patients with OSCC. We hypothesize that alterations in the abundance of ¹³C and ¹⁵N stable isotopes in OSCC tumor tissues reflect metabolic reprogramming associated with tumor progression and may correlate with cervical lymph node metastases. Methods: A prospective cohort of 61 patients with primary OSCC undergoing surgical treatment was analyzed. Tumor tissue samples were evaluated for the relative abundance of nitrogen-15 (¹⁵N) and carbon-13 (¹³C) isotopes using IRMS. Correlations between isotopic values and nodal metastases, as well as established clinicopathological risk factors, were assessed. Results: IRMS measurements of ¹³C and ¹⁵N abundance did not directly correlate with the presence of lymph node metastases but were associated with advanced tumor stages and negative prognostic features, such as angioinvasion/neuroinvasion. The median of the average nitrogen ¹⁵N content was higher in patients with more advanced clinical stages (11.89% in stage IV vs. 11.12% in stages I–III; p = 0.04‰), and the median δ¹³C was lower in stage IV compared to stages I–III (−22.40‰ vs. −22.88‰; p < 0.05). Patients with angioinvasion/neuroinvasion also had a lower median δ¹³C (−22.26‰ vs. −22.75‰; p < 0.05). These findings suggest that IRMS reflects metabolic changes in tumor biology rather than specifically predicting nodal metastases. Multivariate logistic regression identified age, gender, and clinical tumor stage as independent predictors of nodal involvement. Conclusion: IRMS-based isotopic profiling may reflect key metabolic alterations associated with OSCC progression. Although IRMS parameters of carbon ¹³C and nitrogen ¹⁵N were not independently predictive of lymph node status, they were associated with key adverse prognostic features, indicating their potential as adjunctive biomarkers that may complement traditional histopathological evaluation. Full article

Background: Concurrent chemoradiation therapy (CCRT) is the standard treatment for patients with locally advanced cervical cancer (LACC), including those with parametrial or lymphatic metastasis. However, therapeutic outcomes vary, and prognostic factors remain inadequately defined. Methods: We conducted a retrospective study involving 128 patients with cervical cancer who received definitive CCRT between 2003 and 2022 at Seoul National University Bundang Hospital. We evaluated clinicopathological variables, including age, height, body weight, histologic type, tumor size, human papillomavirus (HPV) type, squamous cell carcinoma (SCC) antigen levels, and involvement of the parametrium, lower vagina, and lymph nodes. Survival outcomes were analyzed using Kaplan–Meier curves and Cox proportional hazards models. Results: Stage IIIC1r, according to the 2018 FIGO staging system, was the most common disease stage among the study population. Para-aortic lymph node metastasis was significantly associated with increased recurrence risk (odds ratio [OR] = 5.892; 95% confidence interval [CI]: 2.030–17.097; p = 0.001) and was linked to poorer progression-free survival (PFS, p = 0.001), overall survival (OS, p = 0.014), and treatment-free interval (TFI, p = 0.001). Obesity (body mass index ≥ 25 kg/m²) was also associated with higher recurrence risk (OR = 2.737; 95% CI: 1.093–6.855; p = 0.032) and reduced PFS (p = 0.0089). Conclusions: Para-aortic lymph node metastasis and obesity are significant prognostic factors in patients undergoing definitive CCRT for LACC. These findings highlight the need for risk-adapted treatment strategies and potential incorporation of adjunctive therapies to improve clinical outcomes in high-risk patient subgroups. Full article

Background/Objectives: The preoperative detection of sentinel lymph nodes (SLN) using technetium-99m (Tc-99m) is crucial for surgical staging in early-stage endometrial cancer (EC). The optimal imaging timing and modality remain debated. This study compares early planar scintigraphy (30 min), SPECT/CT (1 h), and 18-h planar scintigraphy after a single Tc-99m injection. Methods: A total of 125 patients with early-stage EC underwent SLN mapping with Tc-99m (120 MBq). Imaging included 30-min planar scintigraphy, SPECT/CT (1 h), and 18-h planar scintigraphy on the day of surgery. Detection sensitivity, the bilateral mapping rate, and image quality (signal-to-noise ratio (SNR), contrast factor (C-factor)) were evaluated, with intraoperative gamma probe detection and histopathology as references. Results: The 18-h planar scintigraphy achieved the highest SLN detection sensitivity (94.4%, 118/125), compared with SPECT/CT (87.2%, OR = 2.48, 95% CI: 0.98–6.27, p = 0.051) and 30-min scintigraphy (72.0%). Only the 18-h protocol underwent intraoperative and histopathological verification; results for 30-min planar and 1-h SPECT/CT were based on imaging alone, which limits direct comparability. Bilateral detection was higher at 18 h (80.80%) than SPECT/CT (73.60%). All SLNs detected at 18 h were confirmed intraoperatively and histologically, yielding 100% PPV (95% CI: 96.9–100.0%) and NPV (95% CI: 59.0–100.0%). The 18-h protocol showed superior imaging contrast (C-factor: 10.30 ± 1.22) despite lower residual activity. The method remained effective in patients with BMI ≥ 30 (94.00%). Only 1.60% of patients required hysterectomy before mapping due to background interference. Conclusions: The 18-h planar scintigraphy is a highly effective, low-cost, and accessible method for SLN detection in early-stage EC, potentially reducing the need for SPECT/CT, radiation exposure, and costs. Full article

Background and Objectives: Breast cancer-related lymphedema (BCRL) is a complication of axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) may help to decrease lymphedema after ALND by creating lymphatic bypasses. This retrospective single-institution study aimed to compare lymphedema in patients undergoing ALND with and without ILR. Materials and Methods: Bioimpedance and limb measurements determined the presence of BCRL. The categorical data that were collected and analyzed included BMI, comorbidities, BCRL onset, and number of lymphatic bypasses. Pearson’s chi-square test and multivariable logistic regression were performed to identify factors associated with the onset of lymphedema. An odds ratio compared the incidence of BCRL with and without ILR. Results: In total, 186 patients underwent ALND, 44 (24%) with ILR and 142 (76%) without. The mean number of bypasses during ILRs created was 3.54. The odds of developing lymphedema with ILR were 64% lower than for ALND alone. ILR patients who developed BCRL had a mean onset of 543 days post-operatively versus 389 days in the control group. Age, ethnicity, BMI, and bypass amount had no significant influence on lymphedema development. Conclusions: ILR was associated with lower rates of BCRL after ALND. Patients who developed lymphedema despite undergoing ILR did so 8 months later than the controls. Full article

Background. Axillary lymph node biopsy (ALND) has traditionally been considered the gold standard for axillary staging and treatment in clinically node-positive breast cancer patients. However, in patients with nodal disease, the therapeutic benefit of ALND is uncertain. This study, based on a large cohort, aims to evaluate breast cancer-specific survival depending on the extent of axillary surgery in non-metastatic breast cancer using real-world data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods. This retrospective cohort study comprised 825,240 patients diagnosed with breast cancer between 2000 and 2020. Results. ALND was associated with a worse survival outcome in pN0 and pN1 populations (respectively, hazard ratio [HR] 1.16; 95% confidence interval [CI] 1.12–1.2; p < 0.001 and HR 1.38; 95%CI 1.3–1.46; p < 0.001). In pN2 and pN3 populations, there was ~4.3% relative reduction in the hazard of breast cancer-related death for each additional node removed; and higher positive-to-removed lymph node ratio was associated with worse prognosis (HR 3.450; 95%CI 2.99–3.98; p < 0.001). Conclusions. SLNB is associated with significantly better specific survival compared to ALND in negative/low axillary involvement, in higher axillary involvement categories extensive axillary surgery was associated with better prognosis. Full article

Systemic inflammation plays a key role in cancer progression, and markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have gained attention as potential prognostic tools in colorectal cancer. However, their comparative utility in colon cancer remains unclear. Objective: This study was aimed to assess and compare the prognostic value of preoperative NLR and PLR in evaluating tumor aggressiveness in colon cancer patients undergoing elective surgery. Methods: We conducted a retrospective observational study on 64 patients with histologically confirmed colon cancer treated between 2019 and 2022. Only elective cases were included; rectal and emergency surgeries were excluded. Demographic, clinical, pathological, and laboratory data were collected. Tumor aggressiveness was assessed based on tumor size, histologic grade, lymphovascular and perineural invasion, and lymph node involvement. Statistical analysis included Pearson correlation, ANCOVA, logistic regression, and principal component analysis (PCA). Results: PLR showed a significant positive correlation with tumor size (r = 0.428, p < 0.001) and tumor stage (r = 0.314, p = 0.012), whereas NLR did not. Logistic regression and PCA indicated that PLR better reflected tumor burden, while NLR was more associated with systemic inflammation. Neither marker significantly predicted postoperative complications or in-hospital mortality. Conclusions: PLR may serve as a useful, non-invasive biomarker for assessing tumor aggressiveness in colon cancer, supporting its integration into preoperative risk stratification. The results from this single-center, retrospective cohort showed moderate associations between PLR and tumor size and stage, whereas NLR did not. These findings are hypothesis-generating and insufficient for clinical implementation; prospective, adequately powered studies with survival endpoints are required. Full article

Background: Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries. Despite advances in diagnosis and treatment, recurrence and mortality remain significant concerns. The neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, has shown prognostic value in several malignancies, but its utility in EC remains underexplored. Objective: To evaluate the prognostic significance of the preoperative NLR in patients with endometrial cancer undergoing primary surgical treatment. Methods: We conducted a retrospective cohort study including 398 patients with histologically confirmed endometrial adenocarcinoma surgically treated at a tertiary cancer center. Preoperative complete blood counts were used to calculate NLR, and a cutoff value of 2.27 was determined through Receiver Operating Characteristic (ROC) analysis. Survival outcomes were assessed using Kaplan–Meier analysis and Cox proportional hazards modeling. Results: Patients with NLR ≥ 2.27 had significantly reduced median overall survival (OS) compared to those with NLR < 2.27 (72.3 vs. 92.8 months, p = 0.008). In multivariate analysis, elevated NLR remained an independent predictor of poorer OS (HR = 1.87; 95% CI: 1.156–3.017; p = 0.011), alongside age ≥ 64 years, lymphovascular space invasion (LVSI), lymph node involvement, and distant metastases. ROC analysis yielded an Area Under the Curve (AUC) of 0.646 for NLR. Notably, vaginal brachytherapy was associated with improved survival (HR = 0.53; p = 0.026), while other adjuvant therapies were not independently significant. Conclusions: Preoperative NLR is an accessible, independent prognostic biomarker in endometrial cancer and may serve as a surrogate indicator of tumor-promoting inflammation and immune dysregulation. Its integration into preoperative assessment could enhance risk stratification and guide personalized treatment strategies. However, findings should be interpreted in light of the study’s retrospective design, single-center setting, and lack of molecular classification data. Prospective validation is warranted to confirm its clinical utility. Full article

Background/Objectives: This study aimed to evaluate the prognostic significance of lymph node density (LND) and the log odds of positive lymph nodes (LODDS) in patients with oral squamous cell carcinoma (OSCC) using a nationwide database. Methods: A retrospective cohort study was conducted using the Taiwan Cancer Registry to identify patients diagnosed with OSCC who underwent surgery for both the primary tumor and neck dissection. Clinicopathological variables were collected, and survival outcomes were analyzed using Cox proportional hazards models. LND was categorized as negative, <0.05, and ≥0.05; LODDS was grouped into four categories: <−4, −4 to −3.5, −3.5 to −2.5, and ≥−2.5. Results: A total of 1643 female and 15,475 male patients were included, with a mean age of 57.4 years (range, 20–98 years). In multivariable Cox regression analyses, LND and LODDS were identified as independent prognostic factors for overall survival. Compared with patients with negative LND, the hazard ratios for LND < 0.05 and LND ≥0.05 were 2.12 (95% CI, 1.90–2.36) and 3.35 (95% CI, 3.05–3.67), respectively (p < 0.01). Similarly, relative to the lowest LODDS group (<−4), the hazard ratios for the higher categories were 1.51 (95% CI, 1.32–1.74) for −4 to −3.5, 2.30 (95% CI, 2.05–2.57) for −3.5 to −2.5, and 4.32 (95% CI, 3.85–4.86) for ≥−2.5 (p < 0.01). Conclusions: LND and LODDS are significant prognostic indicators in OSCC. Incorporating these lymph node–based metrics into prognostic models may enhance risk stratification and inform clinical decision-making. Full article

Background/Objectives: PROX1 (prospero homeobox 1) is a transcription factor involved in lymphangiogenesis and cellular differentiation. Its role in cancer biology appears to be highly context-dependent, with it exhibiting both tumor-promoting and -suppressive functions across various malignancies. Nonetheless, the clinical significance of PROX1 expression in non-small cell lung cancer (NSCLC) remains poorly elucidated. The objective of this study is to evaluate the immunohistochemical expression of PROX1 in NSCLC, specifically in the adenocarcinoma and squamous cell carcinoma subtypes, and to assess its correlation with clinicopathologic features and overall survival (OS). Methods: This retrospective study included surgically resected specimens from 121 patients with histologically confirmed NSCLC. PROX1 expression was assessed via immunohistochemistry on formalin-fixed, paraffin-embedded specimens. Staining intensity (graded 0– National and Kapodistrian University of Athens 3) and the percentage of positive tumor cells were recorded. Correlations with histological subtype, tumor characteristics, and OS were analyzed using chi-square tests, one-way ANOVA, and Kaplan–Meier survival analysis with log-rank testing. Results: Low PROX1 intensity (level 1) was significantly associated with P63 positivity (p = 0.028), while high PROX1 intensity (level 3) correlated with nodal metastasis to station 3 (S3+) (p = 0.025). Additionally, alveolar-pattern adenocarcinomas exhibited intermediate PROX1 expression (26–50%) (p = 0.010). Although PROX1 positivity did not differ among mucinous and non-mucinous adenocarcinomas (p = 0.152), its distribution across defined expression subgroups was statistically significant (p = 0.002). Tumors with low PROX1 expression (0–24%) were associated with a larger maximum tumor diameter (p = 0.026). PROX1 expression was not independently associated with OS (p > 0.05). Factors significantly associated with improved survival included an age < 50 years, female sex, the absence of necrosis, fewer than 10 positive lymph nodes, a lymph node ratio < 0.5, and the absence of extensive nodal involvement in stations 5, 10, 11, and 12. Conclusions: Although PROX1 expression is variably associated with specific histologic subtypes and nodal metastases in NSCLC, it does not independently predict overall survival. Its expression patterns suggest a potential role in tumor differentiation and lymphatic spread. Further mechanistic and immunologic studies are warranted to elucidate the functional significance of PROX1 in lung cancer biology. Full article

Background/Objectives: Gastrin-releasing peptide receptor (GRPR) is overexpressed in breast cancer and might be used as a theranostics target. The expression of GRPR strongly correlates with estrogen receptor (ER) expression. Visualization of GRPR-expressing breast tumors might help to select the optimal treatment. Developing GRPR-specific probes for SPECT would permit imaging-guided therapy in regions with restricted access to PET facilities. In this first-in-human study, we evaluated the safety, biodistribution, and dosimetry of the [^99mTc]Tc-DB8 GRPR-antagonistic peptide. We also addressed the important issue of finding the optimal injected peptide mass. Methods: Fifteen female patients with ER-positive primary breast cancer were enrolled and divided into three cohorts receiving [^99mTc]Tc-DB8 (corresponding to three distinct doses of 40, 80, or 120 µg DB8) comprising five patients each. Additionally, four patients with ER-negative primary tumors were injected with 80 µg [^99mTc]Tc-DB8. The injected activity was 360 ± 70 MBq. Planar scintigraphy was performed after 2, 4, 6, and 24 h, and SPECT/CT scans followed planar imaging 2, 4, and 6 h after injection. Results: No adverse events were associated with [^99mTc]Tc-DB8 injections. The effective dose was 0.009–0.014 mSv/MBq. Primary tumors and all known lymph node metastases were visualized irrespective of injected peptide mass. The highest uptake in the ER-positive tumors was 2 h after injection of [^99mTc]Tc-DB8 at a 80 µg DB8 dose (SUV_max 5.3 ± 1.2). Injection of [^99mTc]Tc-DB8 with 80 µg DB8 provided significantly (p < 0.01) higher uptake in primary ER-positive breast cancer lesions than injection with 40 µg DB8 (SUV_max 2.0 ± 0.3) or 120 µg (SUV_max 3.2 ± 1.4). Tumor-to-contralateral breast ratio after injection of 80 μg was also significantly (p < 0.01, ANOVA test) higher than ratios after injection of other peptide masses. The uptake in ER-negative lesions was significantly lower (SUV_max 2.0 ± 0.3) than in ER-positive tumors. Conclusions: Imaging using [^99mTc]Tc-DB8 is safe, tolerable, and associated with low absorbed doses. The tumor uptake is dependent on the injected peptide mass. The injection of an optimal mass (80 µg) provides the highest uptake in ER-positive tumors. At optimal dosing, the uptake was significantly higher in ER-positive than in ER-negative lesions. Full article

Background: MRI-based radiomics has emerged as a promising approach to enhance the non-invasive, presurgical assessment of lymph node staging in rectal cancer (RC). However, its clinical implementation remains limited due to methodological variability in published studies. We conducted a systematic review and meta-analysis to synthesize the diagnostic performance of MRI-based radiomics models for predicting pathological nodal status (pN) in RC. Methods: A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published until 31 December 2024. Eligible studies applied MRI-based radiomics for pN prediction in RC patients. We excluded other imaging sources and models combining radiomics and other data (e.g., clinical). All models with available outcome metrics were included in data analysis. Data extraction and quality assessment (QUADAS-2) were performed independently by two reviewers. Random-effects meta-analyses including hierarchical summary receiver operating characteristic (HSROC) and restricted maximum likelihood estimator (REML) analyses were conducted to pool sensitivity, specificity, area under the curve (AUC), and diagnostic odds ratios (DORs). Sensitivity analyses and publication bias evaluation were also performed. Results: Sixteen studies (n = 3157 patients) were included. The HSROC showed pooled sensitivity, specificity, and AUC values of 0.68 (95% CI, 0.63–0.72), 0.73 (95% CI, 0.68–0.78), and 0.70 (95% CI, 0.65–0.75), respectively. The mean pooled AUC and DOR obtained by REML were 0.78 (95% CI, 0.75–0.80) and 6.03 (95% CI, 4.65–7.82). Funnel plot asymmetry and Egger’s test (p = 0.025) indicated potential publication bias. Conclusions: Overall, MRI-based radiomics models demonstrated moderate accuracy in predicting pN status in RC, with some studies reporting outstanding results. However, heterogeneity in relevant methodological approaches such as the source of MRI sequences or machine learning methods applied along with possible publication bias call for further standardization and preclude their translation to clinical practice. Full article

Objectives: To quantify inpatient palliative care use over time and to test whether patient or hospital characteristics represent determinants of inpatient palliative care use in patients with metastatic penile cancer. Methods: Relying on the National Inpatient Sample database (2006–2019), we identified 1017 metastatic penile cancer patients. Estimated annual percentage change analyses and multivariable logistic regression models addressing inpatient palliative care use were fitted. Results: Of 1017 metastatic penile cancer patients, 139 (13.7%) received inpatient palliative care. Over time, the proportion of inpatient palliative care use per year increased from 6.5% in 2006 to 17.8% in 2019 (estimated annual percentage change +6.7%; p = 0.001). In the multivariable logistic regression models, contemporary study years (odds ratio [OR] 1.80; p = 0.003), the presence of bone metastases (OR 1.90; p = 0.002) and the presence of brain metastases (OR 2.60; p = 0.013) independently predicted higher inpatient palliative care use. Conversely, distant lymph node metastases independently predicted lower inpatient palliative care use (OR 0.58; p = 0.022). Finally, hospital admission in the South (OR 2.42; p = 0.007) and in the Northeast (OR 2.34; p = 0.015) was associated with higher inpatient palliative care use than hospital admission in the Midwest. Conclusions: In metastatic penile cancer patients, the proportions of inpatient palliative care use were low but have increased over time. Unfortunately, some geographical regions are more refractory to inpatient palliative care use than others. Finally, specific patient characteristics such as bone metastases and brain metastases represent independent predictors of higher inpatient palliative care use. Full article