Prognostic Values of Different Clinicopathological Factors and Predictive Models for Penile Carcinoma

Figures & data

Table 1 Clinicopathological Features and CSS Rates for 311 PSCC Patients

Variants	Number	1-Year CSS	2-Year CSS	5-Year CSS	P value
Age of diagnosis (years)					0.552
<50	132	88.2%	78.9%	76.5%
50–69	134	93.5%	85.7%	79.2%
≥70	45	90.5%	76.2%	76.2%
Smoking history					0.827
No	142	90.8%	84.8%	78.1%
Yes	169	90.8%	79.3%	77.2%
Tumor growth velocity					0.100
<1.5 cm/ recent 3 months	158	91.9%	84.1%	81.0%
≥1.5 cm/ recent 3 months	153	88.8%	80.2%	73.9%
Tumor location					0.078
Prepuse	15	93.3%	93.3%	93.3%
Glans of penis	288	90.8%	81.8%	77.2%
Body of penis	8	87.5%	48.6%	48.6%
Tumor size					0.127
<3cm	149	91.3%	83.9%	81.8%
≥3cm	162	90.3%	79.8%	73.8%
ILND operation					0.001
No surgery or unknown	165	97.3%	94.2%	92.1%
Prophylactic ILND	28	96.3%	92.3%	87.4%
Therapeutic ILND	118	80.3%	61.8%	55.4%
T stage (8th edition)					0.001
T1	112	95.2%	93.0%	91.6%
T2	103	91.4%	77.8%	72.7%
T3	88	86.2%	74.1%	68.0%
T4	8	71.4%	57.1%	42.9%
T stage (7th and 6th editions)^a					0.001
T1	112	95.2%	93.0%	91.6%
T2	174	88.4%	75.3%	71.3%
T3	17	94.1%	81.6%	65.3%
T4	8	71.4%	57.1%	42.9%
Nuclear grade					0.001
Well differentiated	101	99.0%	96.6%	90.9%
Moderately differentiated	148	92.7%	83.8%	79.1%
Poorly/ undifferentiated	62	72.8%	53.0%	50.6%
Lymph vascular invasion					0.001
Negative	287	92.3%	85.6%	82.2%
Positive	24	74.1%	39.5%	24.7%
N stage (8th edition)					0.001
cN0	141	99.2%	97.2%	94.7%
cN+	23	90.4%	80.1%	80.1%
pN0	59	93.0%	89.3%	84.9%
pN1	26	95.8%	95.8%	79.9%
pN2	39	79.7%	47.5%	30.2%
pN3	23	42.9%	0.0%	0.0%
N stage (7th edition)					0.001
cN0	141	99.2%	97.2%	94.7%
cN+	23	90.4%	80.1%	80.1%
pN0	59	93.0%	89.3%	84.9%
pN1	22	94.7%	94.7%	94.7%
pN2	42	81.5%	53.4%	38.2%
pN3	24	43.4%	0.0%	0.0%
N stage (6th edition)					0.001
cN0	141	99.2%	97.2%	94.7%
cN+	23	90.4%	80.1%	80.1%
pN0	59	93.0%	89.3%	84.9%
pN1	23	94.7%	94.7%	94.7%
pN2	43	78.5%	47.7%	33.0%
pN3	22	53.7%	7.4%%	0.0%
AJCC stage (8 and 7th editions)^b					0.001
I	89	100.0%	98.6%	97.0%
II	107	94.7%	91.0%	87.1%
III	84	88.0%	73.3%	65.7%
IV	31	53.3%	16.4%	12.3%
AJCC stage (6th editions)					0.001
I	89	100.0%	98.6%	97.0%
II	124	94.5%	92.3%	90.4%
III	70	84.0%	61.2%	50.1%
IV	28	59.5%	25.7%	20.6%
Metastasis					0.001
No	274	94.7%	89.9%	88.8%
Yes	37	64.9%	30.4%	6.8%

Notes: ^aThe same classificatory results for 7th and 6th T stage were seen in our cohorts, so they were described together; ^bthe same classificatory results for 8th/ 7th AJCC prognostic stage group were seen in our cohorts, so they were described together.

Abbreviations: CSS, cancer specific survival; PSCC, penile squamous cell carcinoma; CI, confidence interval; ILND, Inguinal lymph node dissection; AJCC, American Joint Committee on Cancer.

Table 2 Univariate Analysis for CSS in 311 PSCC Patients

Clinical Pathological Data	P value	Hazard Ratio	95% CI
Smoking^a	0.827	1.059	0.631–1.778
50≤Diagnosis age <70 years^b	0.476	0.752	0.344–1.644
Diagnosis age >70 years^b	0.967	1.016	0.479–2.155
Tumor in glans penis^c	0.194	3.706	0.512–26.809
Tumor in body of penis^c	0.048	9.830	1.019–94.802
Tumor size ≥3cm^d	0.130	1.501	0.887–2.541
Tumor growth ≥1.5cm/ recent 3 months^e	0.103	1.542	0.917–2.593
T2 (7th and 6th editions)^f	0.001	3.919	1.836–8.367
T3 (7th and 6th editions)^f	0.015	4.007	1.310–12.255
T4 (7th and 6th editions)^f	0.001	9.643	2.896–32.112
T2 (8th edition)^f	0.003	3.360	1.495–7.553
T3 (8th edition)^f	0.001	4.652	2.087–10.366
T4 (8th edition)^f	0.001	9.647	2.897–32.123
Moderately differentiated^g	0.011	2.968	1.286–6.848
Poorly/undifferentiated^g	0.001	9.492	4.067–22.157
Lymph vascular invasion^h	0.001	5.990	3.285–10.924
cN+ (8th edition)^i	0.056	2.983	0.973–9.152
pN1 (8th edition)^i	0.363	1.790	0.510–6.285
pN2 (8th edition)^i	0.001	14.822	7.243–30.332
pN3 (8th edition)^i	0.001	58.254	26.594–127.605
cN+ (7th edition)^i	0.056	2.986	0.974–9.160
pN1 (7th edition)^i	0.169	2.417	0.688–8.489
pN2 (7th edition)^i	0.001	10.881	5.344–22.155
pN3 (7th edition)^i	0.001	55.582	25.528–121.020
cN+ (6th edition)^i	0.013	3.708	1.322–10.403
pN1 (6th edition)^i	0.173	2.393	0.681–8.404
pN2 (6th edition)^i	0.001	12.208	6.082–24.505
pN3 (6th edition)^i	0.001	34.963	16.171–75.596
AJCC group II (8th and 7th editions)^j	0.039	4.966	1.088–22.673
AJCC group III (8th and 7th editions)^j	0.001	17.693	4.177–74.947
AJCC group IV (8th and 7th editions)^j	0.001	92.914	21.591–399.845
AJCC group II (6th edition)^j	0.043	4.752	1.053–21.444
AJCC group III (6th edition)^j	0.001	25.505	6.065–107.408
AJCC group IV (6th edition)^j	0.001	69.474	15.975–302.144

Notes: ^aReference group is no-smoker; ^breference group is diagnosis age <50; ^creference group is tumor in prepuce; ^dreference group is tumor size < 3cm; ^ereference group is Tumor growth < 0.5 cm/month; ^fthe same classificatory results for 7th and 6th T stage were seen in our cohorts, so they were described together. The reference group is T_1; ^greference group is nuclear well differentiated group; ^hreference group is lymph vascular invasion negative group; ⁱreference group is cN₀/pN₀ group; ^jthe same classificatory results for 8th/ 7th AJCC prognostic stage group were seen in our cohorts, so they were described together. The reference group is AJCC group I.

Abbreviations: CSS, cancer specific survival; PSCC, penile squamous cell carcinoma; CI, confidence interval; AJCC, American Joint Committee on Cancer.

Table 3 Predictive Value of Different Variants and Prognostic Models in 311 PSCC Patients

Variants and Prognostic Models	c-Index	(95% CI)
Tumor site^a	0.535	0.496–0.573
T stage (8th edition)	0.650	0.582–0.718
T stage (7th and 6th edition)^b	0.630	0.569–0.691
N stage (8th edition)^c	0.814	0.756–0.873
N stage (7th edition)^c	0.811	0.752–0.869
N stage (6th edition)^c	0.801	0.744–0.859
Nuclear grade	0.711	0.651–0.771
Lymph vascular invasion	0.600	0.548–0.653
AJCC stage (8 and 7th editions)^d	0.821	0.774–0.868
AJCC stage (6th edition)	0.823	0.777–0.869
SEER + grade nomogram^e	0.738	0.681–0.795
TNM + grade nomogram^e	0.792	0.739–0.846
AJCC + grade nomogram^e	0.831	0.787–0.875
T1-3 + N+ grade nomogram^f	0.781	0.710–0.851
Novel nomogram 1	0.870	0.829–0.911
Novel nomogram 2	0.855	0.815–0.896

Notes: ^aTumor site was distinguished as: prepuce, glans of penis, body of penis; ^bthe same classificatory results for 7th and 6th T stage were seen in our cohorts, so they were described together; ^clymph node status was distinguished as: cN₀/pN₀, cN₊, pN₁, pN₂, pN₃. ^dThe same classificatory results for 8th/ 7th AJCC prognostic stage group were seen in our cohorts, so they were described together; ^ereported by Thuret et al;⁷ freported by Thuret et al.⁸

Abbreviations: PSCC, penile squamous cell carcinoma; CI, confidence interval; SEER, Surveillance, Epidemiology, and End Results program; AJCC, American Joint Committee on Cancer.

Figure 1 Novel nomogram 1 predicting cancer-specific survival of postoperative PSCC patients.

Figure 2 Novel nomogram 2 predicting cancer-specific survival of postoperative PSCC patients.

Abbreviation: AJCC, American Joint Committee on Cancer.

Figure 3 ROC curve of different models. (A) ROC of predictive models in 311 PSCC cases. (B) ROC of predictive models in 303 T1-3 cases. ^aReported by Thuret et al;⁷ breported by Thuret et al.⁸

Abbreviations: AJCC, American Joint Committee on Cancer; AUC, Area Under the Curve; ROC, Receiver Operating Characteristic Curve; SEER, Surveillance, Epidemiology, and End Results Program.

Thuret R, Sun M, Abdollah F, et al. Tumor grade improves the prognostic ability of American Joint Committee on Cancer stage in patients with penile carcinoma. J Urol. 2011;185(2):501–507.21167526

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