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      Validation of predictors for lymph node status in penile cancer: Results from a population-based cohort

      , MD MPH 1 , , MD 2 , , MD, MSc PhD 3 , , MD 1 , , MD , 1

      Canadian Urological Association Journal

      Canadian Medical Association

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          Abstract

          Introduction

          The ability to predict lymph node (LN) status is essential in the management of men with localized squamous cell carcinoma (SCC) of the penis. There has been limited external validation of available risk stratification tools, particularly in routine clinical care. The objective of this study was to evaluate the predictive variables of LN metastases within a large population-based cohort of patients.

          Methods

          In this population-based cohort study, surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients who were diagnosed with penile cancer in Ontario, Canada. Multivariable analyses were performed to evaluate predictive variables for LN involvement. Three contemporary risk stratification schemes used to predict LN status were analyzed by logistic regression.

          Results

          The study included 380 localized penile SCC cases treated between 2000 and 2010. Sixty-three (17%) had pathologically confirmed LN metastases. Among these, 35 (56%) were diagnosed within three months of the initial penile SCC diagnosis and these patients had a worse five-year disease-specific survival (43%; 95% confidence interval [CI] 26–64) compared to patients who were diagnosed at a delayed LN dissection. On multivariable analysis, age (odds ratio [OR] 0.68; 95% CI 0.52–0.88), pathological stage (≥pT1b; OR 3.32; 95% CI 1.38–8.01), and tumour grade (Grade 2 OR 2.98; 95% CI 1.26–7.62; Grade 3 OR 3.97; 95% CI 1.32–11.9) were associated with an increased risk of LN metastases. Candidate risk stratification schemes demonstrated moderate to good property, with C-statistics ranging from 0.662–0.747.

          Conclusions

          Using a population-based cohort of penile cancer patients with a relatively low proportion of patients with pathologically confirmed LN involvement, we confirm and externally validate the importance of age, stage, and grade of the primary tumour in predicting nodal status.

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          Author and article information

          Journal
          Can Urol Assoc J
          Can Urol Assoc J
          CUAJ
          Canadian Urological Association Journal
          Canadian Medical Association
          1911-6470
          1920-1214
          April 2018
          22 December 2017
          : 12
          : 4
          : 119-125
          Affiliations
          [1 ]Department of Oncology, Queen’s University, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON
          [2 ]Department of Urology, Queen’s University, Kingston General Hospital, Kingston, ON
          [3 ]Department of Radiation Oncology, Western University, London Health Sciences Centre, London, ON; Canada
          Author notes
          Correspondence: Dr. Aamer Mahmud, Department of Oncology, Queen’s University, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON, Canada; aamer.mahmud@ 123456krcc.on.ca
          Article
          PMC5905539 PMC5905539 5905539 cuaj-4-119
          10.5489/cuaj.4711
          5905539
          29319487
          Copyright: © 2018 Canadian Urological Association or its licensors
          Categories
          Original Research

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