Open AccessProposal for reclassification of N staging system in penile cancer patients, based on number of positive lymph nodes
Author(s) -
Li Zhiyong,
Guo Shengjie,
Wu Zhiming,
Han Hui,
Li Zaishang,
Wang Yanjun,
Chen Jieping,
Deng Chuangzhong,
Qin Zike,
Liu Zhuowei,
Li Yonghong,
Chen Dong,
Zhou Fangjian,
Yao Kai
Publication year - 2018
Publication title -
cancer science
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.035
H-Index - 141
eISSN - 1349-7006
pISSN - 1347-9032
DOI - 10.1111/cas.13484
Subject(s) - medicine , penile cancer , hazard ratio , metastasis , concordance , lymph , cancer , oncology , urology , gastroenterology , pathology , confidence interval
In the present study, we aim to compare the rationality of proposed N classification based on the number of metastatic lymph nodes (LNs) with the current one. A total of 509 penile cancer patients at our institute were analyzed. Univariable and multivariable statistical analyses were used to assess cancer‐specific survival ( CSS ) in 2 staging systems. Harrell's concordance index was applied to evaluate predictive accuracy of the current and proposed N classification in predicting CSS . We propose a new classification: pN 1 (metastasis in 1‐2 regional LN s), pN 2 (metastasis in 3 regional LN s, or 3 or fewer regional lymph nodes with extranodal extension), and pN 3 (metastasis in 4 or more regional LN s). According to the current and proposed N classification, the 5‐year CSS of penile cancer patients with pN 1, pN 2 and pN 3 was 85.8%, 39.0%, and 19.7%; and with pN 1, pN 2 and pN 3 was 79.8%, 39.3% and 15.3%, which almost all showed significant difference ( P < .001, P = .259) ( P < .001, P < .001). Multivariable predictive accuracy of the proposed and current N staging was 76.48% and 70.92% (5.56% gain; P < .001). With a multivariable model of clinical features, both current (hazard ratio [ HR ], 7.761, 10.612; P < .001, P < .001) and proposed N stages ( HR , 3.792, 3.971; P < .001, P < .001) exhibited independent effects on survival. The proposed N classification is superior to the current one, which is simpler and provides more accurate prognosis.