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A modified clinicopathological tumor staging system for survival prediction of patients with penile cancer

Cancer Communications 2018年第1期38卷 726-735页

作者： Zai-Shang Li Antonio Augusto Ornellas Christian Schwentner Xiang Li Alcides Chaux Georges Netto Arthur LBurnett Yong Tang jiunhung 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 Wang Zi-Ke Qin Zhuo-Wei Liu Yong-Hong Li Zi-Jun Zou Jun-Hang Luo Hui Li Hui Han Fang-Jian Zhou Department of Urology Shenzhen People’s HospitalThe Second Clinical College of Jinan UniversityShenzhen 518060GuangdongP.R.China Sun Yat-sen University Cancer Center State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhou 510060GuangdongP.R.China Department of Urology Sun Yat-sen University Cancer Center651 Dongfeng RoadEast Guangzhou 510060GuangdongP.R.China Department of Urology Brazilian National Institute of Cancer and Hospital Mário KröeffRio de Janeiro 20230-130Brazil Section of Urology National Institute of CancerRio de JaneiroBrazil Department of Urology Diakonie Klinikum Stuttgart70174 StuttgartGermany Urological Department Urological InstituteWest China Hospital of Sichuan UniversityChengdu 610041SichuanP.R.China Department of Scientific Research Norte University1001-1925 AsunciónParaguay Department of Pathology Johns Hopkins UniversityBaltimoreMD 21218USA Department of Urology Johns Hopkins UniversityBaltimoreMD 21218USA Department of Urology Affiliated Cancer Hospital of Guangxi Medical UniversityNanning 530021GuangxiP.R.China Department of Urology Kaohsiung Medical University HospitalKaohsiungTaiwan 807China Department of Urology The First People’s Hospital of ChenzhouChenzhou 423000HunanP.R.China Department of Urology Cancer Center of Guangzhou Medical UniversityGuangzhou 510000GuangdongP.R.China Department of Urology Sichuan Cancer HospitalChengdu 610041SichuanP.R.China Department of Urology Oncological Surgery Chongqing Cancer Hospital&Institute&Cancer CenterChongqing 400040China Department of Urology Affiliated Tumor Hospital of Xinjiang Medical UniversityUrumqi 830011XinjiangP.R.China Department of Urology Yunnan Provincial Tumor HospitalThe Third Affiliated Hospital of Kunming Medical UniversityKunming 650118YunnanP.R.China Department of Urology Dongguan People’s HospitalDongguan 523059GuangdongP.R.China Department of Pathology Sun Yat-sen University Cancer CenterGuangzhou 510060Guangdo

Background:The 8th American Joint Committee on Cancer tumor-node-metastasis(AJCC-TNM)staging system is based on a few retrospective single-center *** aimed to test the prognostic validity of the staging system and to determine whether a modified clinicopathological tumor staging system that includes lymphovascular emboliza-tion could increase the accuracy of prognostic prediction for patients with stage T2-3 penile ***: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 *** internal validation was analyzed by bootstrap-corrected C-indexes(resampled 1000 times).Data from 436 patients who were treated at 15 centers over four conti-nents were used for external ***:A survivorship overlap was observed between T2 and T3 patients(P=0.587)classified according to the 8th AJCC-TNM staging *** 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 influ-ence 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 lymphovascu-lar 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 *** 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 accur

关键词： Penile neoplasms Lymph node metastasis Staging Lymph node excision Prognosis

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