Abstract
PurposePenile cancer is a rare male neoplasm with a wide variation in its global incidence. In this study, the prognostic value of lymph node ratio (LNR) was compared to that of positive lymph node count (PLNC) in penile squamous cell carcinoma.MethodsA total of 249 patients with penile squamous cell carcinoma were enrolled from The Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. The X-tile program was used to calculate the optimal cut-off values of LNR and PLNC that discriminate survival. We used the χ2 or the Fisher exact probability test to assess the association between clinical-pathological characteristics and LNR or PLNC. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors for survival. Spearman correlation analysis was used to determine the correlation between LNR and PLNC.ResultsWe found that patients with high LNR tended to have advanced N stage, the 7th AJCC stage, and higher pathological grade, while patients with high PLNC had advanced N stage and the 7th AJCC stage. Univariate Cox regression analysis revealed that the N stage, M stage, the 7th AJCC stage, lymph-vascular invasion, LNR, and PLNC were significantly associated with prognosis. Multivariate Cox regression analysis demonstrated that LNR rather than PLNC was an independent prognostic factor for cancer-specific survival. Subgroup analysis of node-positive patients showed that LNR was associated with CSS, while PLNC was not.ConclusionLNR was a better predictor for long-term prognosis than PLNC in patients with penile squamous cell carcinoma.
Highlights
Penile cancer (PC) is a relatively rare disease in developed countries, with approximately 2200 new cases of PC reported in 2020 in the US [1]
A total of 249 patients with penile squamous cell carcinoma (PSCC) were recruited from the SEER database
Our results revealed that high lymph node ratio (LNR) patients tended to have advanced N stage (P < 0.001), the 7th AJCC stage (P < 0.001), and higher pathological grade (P = 0.048) while no significant association was found with other characteristics
Summary
Penile cancer (PC) is a relatively rare disease in developed countries, with approximately 2200 new cases of PC reported in 2020 in the US [1]. PC remains a significant public health concern since it has a considerably higher incidence in developing countries [2, 3]. PC is most common in men aged between 50 and 70 [4]. Squamous cell carcinoma (SCC) is the most common type of penile cancer, accounting for approximately 95% of malignant neoplasms of the penis, other histological types have been reported [5]. Patients with early-stage PC generally have a favorable prognosis; the 5-year cancer-specific survival precipitously declines with lymph node metastasis [6]. More effective therapeutic strategies and better prognostic predictors are needed for PSCC patients
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