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.
Highlights
Penile cancer (PeCa) is a rare disease, but its incidence has been rising slowly in recent years
According to the current research on the TNM staging of PeCa, the number of positive lymph nodes (LNs) can predict the overall survival (OS), like other tumors, the resection quantity of LN metastasis is affected by various factors in survival analysis, such as LN resection method, pathologist’s evaluation and individual physiological changes, these mask the true degree of LN involvement to a certain extent [6,7,8,9]
Using the receiver operating characteristic (ROC) curve, we found that the recommended cutoff values of examined lymph node (ELN) and lymph node density (LND) were 13 [sensitivity, 50.9; specificity, 64.4; AUC, 0.59; P
Summary
Penile cancer (PeCa) is a rare disease, but its incidence has been rising slowly in recent years. According to the current research on the TNM staging of PeCa, the number of positive LNs can predict the overall survival (OS), like other tumors, the resection quantity of LN metastasis is affected by various factors in survival analysis, such as LN resection method, pathologist’s evaluation and individual physiological changes, these mask the true degree of LN involvement to a certain extent [6,7,8,9]. Few 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
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