Modification of N staging systems for penile cancer: a more precise prediction of prognosis

Abstract

Background:The tumour-node-metastasis (TNM) classification is the most widely used tool for penile cancer. However, the current system is based on few studies and has been unchanged since 2009. We determined whether a modified pathological N staging system that incorporates the laterality and number of lymph node metastases (LNMs) increases the accuracy of the results in predicting survival compared with the 7th edition of the pathological N staging system of the American Joint Committee on Cancer (AJCC) for penile cancer.Methods:The clinical and histopathologic data from 111 patients with penile cancer with LNMs were analysed. Univariate and multivariate Cox proportional hazard regression analyses were used to determine the impact of the clinical and pathological factors on disease-specific survival of these patients. The predictive accuracy was further assessed using the concordance index.Results:According to the 7th edition of the pathological N classification, the 3-year disease-specific survival (DSS) rates for patients with pN1, pN2, and pN3 disease are 89.6%, 65.9%, and 33.6%, respectively (PN1–N2=0.030, PN2–N3<0.001, P<0.001). Under the modified pathological N category criteria, the 3-year DSS rates for pN1, pN2, and pN3 patients were 90.7%, 60.5%, and 31.4%, respectively (PN1–N2=0.005, PN2–N3=0.004, P<0.001). In separate multivariate Cox regression models, only modified N stages (hazard ratio: 4.877, 10.895; P=0.018, P<0.001) exhibited independent effects on the outcome. The accuracy of the modified pathological N category was significantly increased.Conclusions:The modified pathological N staging system is a better reflection of the prognosis of patients with penile cancer. Our study should contribute to the improvement of prognostic stratification and systemic treatment to avoid overtreatment of patients.

Proposal for reclassification of N staging system in penile cancer patients, based on number of positive lymph nodes

“…Second, our study found no significant difference in the CSS of patients with penile cancer between those with unilateral and those with bilateral LNM, which included those patients with 2 or more positive LNs (the same positive LNs). Previous studies reported that bilateral metastasis may increase the probability for migration, having a negative impact on survival . When comparing the survival difference between patients with unilateral vs bilateral LNM, we considered including patients with at least 2 LNs positive for metastatic disease to be meaningful, yielding findings different from those reported previously.…”

“…It's possible that the rate of regional recurrence was underestimated. However, a prior study reported that local or regional nodal recurrences usually occur within 2 years of primary treatment . Further research involving longer follow‐up may help reduce bias.…”

Elevated serum LAMC2 is associated with lymph node metastasis and predicts poor prognosis in penile squamous cell carcinoma

“…Serologic markers are more accessible for detection compared to the pathologic parameters, although pathologic indicators are the most important prognostic factors, especially the N stage. 3 Serum markers, such as AFP, CEA, PSA, and CA19.9, have been widely applied in clinical practice as adjuncts to clinicopathologic parameters for monitoring tumor progression and predicting survival. [10][11][12] However, few valuable prognostic serologic factors have been identified in PSCC.…”

“…2 The involvement of local lymph nodes (LNs) is the major prognostic factor in PSCC. [3][4][5] The main treatment for PSCC is currently a partial or radical penectomy with or without bilateral inguinal Dovepress Dovepress 2984 Zhou et al lymphadenectomy, along with radiation, chemotherapy, and targeted therapy. 1,[6][7][8][9] Some classical serum biomarkers (such as CEA, AFP, PSA, and CA-199) are clinically useful in many cancers [10][11][12] ; however, they are not suitable in penile cancer.…”

On staging of urologic cancers in accordance with the updated 8th edition of the TNM Classification

“…Стадирование регионарных ЛУ также претерпело определенные изменения (по версии AJCC). На основании данных опухолевоспецифической выживаемости в зависимости от числа пораженных ЛУ [37] в обновленной классификации расширена категория pN1: включает метастаз не только в 1 паховом ЛУ (как указывалось в 7-м издании), но и в 2 паховых ЛУ при обязательных условиях одностороннего поражения и отсутствия экстракапсулярного роста. К pN2 теперь относится поражение 3 и более ипсилатеральных паховых ЛУ (ранее -поражение и 2 ЛУ) или двустороннее их поражение (уровень доказательности II) также без экстракапсулярного роста.…”