Impact of Examined Lymph Node Count and Lymph Node Density on Overall Survival of Penile Cancer

Abstract

BackgroundFew studies have explored the optimal examined lymph node count and lymph node density cutoff values that could be used to predict the survival of patients with penile cancer. We further clarify the prognostic value of lymph node density and examined lymph node count in penile cancer.MethodsThe Surveillance, Epidemiology, and End Results (SEER) database was explored to recruit penile cancer patients from 2010 to 2015. A retrospective analysis of penile cancer patients’ data from the First Affiliated Hospital of Anhui Medical University was performed for verification (2006–2016). The cutoff values of examined lymph node count and lymph node density were performed according to the ROC curve. Kaplan-Meier survival analysis was used to compare survival differences among different groups. Univariate and multivariate Cox proportional hazard regression analyses were used to determine the significant variables. On the basis of Cox proportional hazards regression model, a nomogram was established and validated by calibration plot diagrams and concordance index (C-index).ResultsA total of 528 patients in the Surveillance, Epidemiology, and End Results cohort and 156 patients in the Chinese cohort were included in this study. Using the ROC curve, we found that the recommended cutoff values of ELN and LND were 13 and 9.3%, respectively (P <0.001). Kaplan–Meier curves suggested the significant differences of overall survival among different examined lymph nodes and lymph node density. Multivariate analysis indicated ELN and LND were independent prognostic factor for OS of penile cancer patients. Nomogram showed the contribution of ELN and LND to predicting OS was large. The C-index at 3-, and 5-year were 0.744 for overall survival (95% CI 0.711–0.777).ConclusionsThe more lymph nodes examined, the lower the density of lymph nodes, and the higher the long-term survival rate of penile cancer. We recommended 13 examined lymph nodes and lymph node density >9.3% as the cutoff value for evaluating the prognosis of penile cancer patients.

Development and Verification of Prognostic Nomogram for Penile Cancer Based on the SEER Database

“…Furthermore, the results of Cox regression analyses suggested the importance of the cancer stage in the prognostic evaluation of patients. However, this seemed that the T stage did not show sufficient prognostic value in the multivariate Cox regression, which was consistent with the result from Gao et al [ 14 ]. In the K-M analysis, the T stage was obviously related to patients' survival.…”

“…As we know, the patient's prognosis is individual. And multiple factors other than TNM staging would have independently affected patients' prognosis, including age, race, marital status, information of surgery, count and density of examined lymph node, and histologic type [ 14 , 15 ]. The nomogram can quantify and analyze these factors more comprehensively than TNM staging system and finally get a more specific value of event probabilities [ 16 ].…”

Erstvorstellung des Pentafecta-Scores als Qualitätsinstrument der Outcome-Bewertung einer chirurgischen Primärtherapie an Patienten mit Peniskarzinom

“…Hierbei ist es möglich, dass der R0-Status den Endpunkt Gesamtmortalität vorhersagt und evtl. auch ein unabhängiger Beitrag von der Anzahl der entfernten ILK ausgeht [10]. Es ist jedoch sehr unwahrscheinlich, dass das Kriterium >CDG-3 den Endpunkt signifikant beeinflusst.…”

“…[5,6,7]. Nichtsdestotrotz gibt es für dieses Kriterium positive Studiendaten, sodass es gering modifiziert in die 13 für den avisierten Pentafecta-Score zur Auswahl stehenden Kriterien übernommen wurde (K3) [10]. Das von Brassetti et al in den Tetrafecta-Score integrierte Kriterium NED-12 Monate wurde jedoch aus bereits dargelegten Gründen in der ersten Runde ausgeschlossen.…”

Reply to May et al. The Goal of Achieving High-Quality Surgical First-Line Therapy in Patients with Penile Cancer Is Important; However, Some Collective Efforts Are Still Required in Order to Reach It. Comment on “Brassetti et al. Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement. Curr. Oncol. 2023, 30, 1882–1892”

“…While the 13 experts enumerated all the available strategies for treating inguinal nodes according to PC stage (including SNB), we chose to focus on patients who were offered a modified (for staging purposes) or radical (with therapeutic intent) ILND by the urologist. We identified a reliable and reproducible criterion based on cadaveric studies to define the adequacy of the lymphadenectomy: a minimum yield of seven LNs from each treated groin [ 9 ] was proposed, since superficial packets contain 4–25 glans (with an average of eight in each extremity), and deeper nodes are not always found [ 10 ]. Additionally, we believe that an uneventful postoperative course is essential to define the success of a surgical procedure, particularly in PC surgery where up to one-third of patients experience adverse events that may require reoperation [ 11 ] and affect their quality of life.…”