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Urol Oncol. 2014 Aug;32(6):893-900. doi: 10.1016/j.urolonc.2013.11.008. Epub 2014 Jun 30.

Disease-specific survival after radical lymphadenectomy for penile cancer: prediction by lymph node count and density.

Author information

1
Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
2
Department of Urology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China.
3
Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Urology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China. Electronic address: hanhui@sysucc.org.cn.

Abstract

OBJECTIVE:

To investigate the value of removed lymph node (LN) count and LN density (LND) for predicting disease-specific survival (DSS) rate following radical lymphadenectomy in patients with penile cancer.

METHODS:

We retrieved data from 146 patients who were surgically treated between 2002 and 2012. receiver-operating characteristic curve analysis was used to calculate the optimal cutoff value of LN count and LND for predicting DSS rate. LND was analyzed as a categorical variable by grouping patients with pN+tumors into 2 categories. Multivariate Cox regression analysis was used to test the effect of various variables on DSS rate based on collinearity in various models.

RESULTS:

Median follow-up was 42 months. Overall, 75 patients (51.4%) had pN0 disease, and 71 patients (48.6%) had pN+disease. The optimal cutoff value of LN count and LND were 16% and 16%, respectively. Among patients with pN0 tumors, the number of LNs removed (≥16 LNs) was an independent significant predictor of DSS rate in univariate and multivariate analyses (all P<0.05). Stratifying pN+ patients as above versus below the LND threshold demonstrated significant differences in 5-year DSS: 81.2% versus 24.4% (P < 0.001). In multivariate models including known prognostic factors, LND was a statistically significant independent predictor of DSS rate (hazard ratio = 4.31 and 3.96 for above vs. below the LND threshold, respectively).

CONCLUSIONS:

The removal of at least 16 LNs was associated with a significantly longer DSS rate in patients with pN0 penile cancer. Additionally, an LND above 16% is an independent predictor of DSS rate in patients with pN+tumors. Further independent validation is required to determine the clinical usefulness of LN count and LND in this patient population.

KEYWORDS:

Lymph node excision; Lymph nodes; Penile neoplasms; Penis; Prognosis

PMID:
24994488
DOI:
10.1016/j.urolonc.2013.11.008
[Indexed for MEDLINE]
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