OBJECTIVE: To evaluate the association between lymph node ratio (LNR) and cancer-specific survival (CSS) in a population of patients with penile cancer and lymph node metastases (LNM).
PATIENTS AND METHODS: We evaluated 81 patients with pathologically-determined LNM who were surgically treated at our Institution between 2000 and 2012. - LNR was considered both as a continuously-coded and as a categorically-coded variable. The minimum p-value approach was used to determine the most significant LNR cut-off value. -The Kaplan-Meier method was used to determine CSS rates. Univariable and multivariable Cox regression models were fitted to test the predictors of CSS.
RESULTS: The median number of positive and removed lymph nodes were 2 (IQR: 1-4) and 22 (IQR: 13-30), respectively. Median LNR was 10.3% (IQR: 6.3 -16.6) and the most significant LNR cut-off value was 22%. Median follow-up was 26 months (IQR: 16-62). Overall, 5-year CSS rate was 50.5%. After stratification according to LNR, 5-year CSS rates were 65.2 vs. 9.6% in patients with LNR < vs. ≥ 22%, respectively (p< 0.001). At multivariable Cox regression models, after adjusting for several established prognostic factors, LNR emerged as independent predictor of CSS (p≤ 0.012). Finally, LNR significantly improved the accuracy of multivariable Cox regression models by a 4.9-10.5% extent.
CONCLUSIONS: Although further investigations are needed to evaluate the relationship between tumor burden and treatment intensity, lymph node ratio may represent a powerful predictor of CSS in patients with penile cancer and pathologically-determined LNM.
Written by:
Lughezzani G, Catanzaro M, Torelli T, Piva L, Biasoni D, Stagni S, Necchi A, Giannatempo P, Raggi D, Fare E, Colecchia M, Pizzocaro G, Salvioni R, Nicolai N. Are you the author?
Department of Urology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy; Department of Urology, San Raffaele Turro, Fondazione IRCCS Ospedale San Raffaele, Milano, Italy.
Reference: BJU Int. 2013 Oct 15. Epub ahead of print.
doi: 10.1111/bju.12510
PubMed Abstract
PMID: 24128128
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