A modified clinicopathological tumor staging system for survival prediction of patients with penile cancer ChiCTR16008041 ChiCTR 11 Medical and Health Sciences 1112 Oncology and Carcinogenesis

Zai Shang Li, Antonio Augusto Ornellas, Christian Schwentner, Xiang Li, Alcides Chaux, Georges Netto, Arthur L. Burnett, Yong Tang, Jiun Hung Geng, Kai Yao, Xiao Feng Chen, Bin Wang, Hong Liao, Nan Liu, Peng Chen, Yong Hong Lei, Qi Wu Mi, Hui Lan Rao, Ying Ming Xiao, Qi Lin WangZi Ke Qin, Zhuo Wei Liu, Yong Hong Li, Zi Jun Zou, Jun Hang Luo, Hui Li, Hui Han, Fang Jian Zhou

Research output: Contribution to journalArticle

Abstract

Background: The 8th American Joint Committee on Cancer tumor-node-metastasis (AJCC-TNM) staging system is based on a few retrospective single-center studies. We aimed to test the prognostic validity of the staging system and to determine whether a modified clinicopathological tumor staging system that includes lymphovascular embolization could increase the accuracy of prognostic prediction for patients with stage T2-3 penile cancer. Methods: A training cohort of 411 patients who were treated at 2 centers in China and Brazil between 2000 and 2015 were staged according to the 8th AJCC-TNM staging system. The internal validation was analyzed by bootstrap-corrected C-indexes (resampled 1000 times). Data from 436 patients who were treated at 15 centers over four continents were used for external validation. Results: A survivorship overlap was observed between T2 and T3 patients (P = 0.587) classified according to the 8th AJCC-TNM staging system. Lymphovascular embolization was a significant prognostic factor for metastasis and survival (all P < 0.001). Based on the multivariate analysis, only lymphovascular embolization showed a significant influence on cancer-specific survival (CSS) (hazard ratio = 1.587, 95% confidence interval = 1.253-2.011; P = 0.001). T2 and T3 patients with lymphovascular embolization showed significantly shorter CSS than did those without lymphovascular embolization (P < 0.001). Therefore, a modified clinicopathological staging system was proposed, with the T2 and T3 categories of the 8th AJCC-TNM staging system being subdivided into two new categories as follows: t2 tumors invade the corpus spongiosum and/or corpora cavernosa and/or urethra without lymphovascular invasion, and t3 tumors invade the corpus spongiosum and/or corpora cavernosa and/or urethra with lymphovascular invasion. The modified staging system involving lymphovascular embolization showed improved prognostic stratification with significant differences in CSS among all categories (all P < 0.005) and exhibited higher accuracy in predicting patient prognoses than did the 8th AJCC-TNM staging system (C-index, 0.739 vs. 0.696). These results were confirmed in the external validation cohort. Conclusions: T2-3 penile cancers are heterogeneous, and a modified clinicopathological staging system that incorporates lymphovascular embolization may better predict the prognosis of patients with penile cancer than does the 8th AJCC-TNM staging system.

Original languageEnglish (US)
Article number68
JournalCancer Communications
Volume38
Issue number1
DOIs
StatePublished - Nov 23 2018

Keywords

  • Lymph node excision
  • Lymph node metastasis
  • Penile neoplasms
  • Prognosis
  • Staging

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Li, Z. S., Ornellas, A. A., Schwentner, C., Li, X., Chaux, A., Netto, G., Burnett, A. L., Tang, Y., Geng, J. H., Yao, K., Chen, X. F., Wang, B., Liao, H., Liu, N., Chen, P., Lei, Y. H., Mi, Q. W., Rao, H. L., Xiao, Y. M., ... Zhou, F. J. (2018). A modified clinicopathological tumor staging system for survival prediction of patients with penile cancer ChiCTR16008041 ChiCTR 11 Medical and Health Sciences 1112 Oncology and Carcinogenesis. Cancer Communications, 38(1), [68]. https://doi.org/10.1186/s40880-018-0340-x