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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.

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