Lymph node density predicts recurrence and death after inguinal lymph node dissection for penile cancer

Ball, Mark W.; Schwen, Zeyad; Ko, Joan; Meyer, Alexa; Netto, George J.; Burnett, Arthur L.; Bivalacqua, Trinity J.

doi:10.4111/icu.2017.58.1.20

Cited by 17 publications

(13 citation statements)

References 22 publications

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“…Lughezzani et al demonstrated that LND > 22% was a better predictor of DSS (HR, 4.58; p < .001) than TNM staging (HR, 2.57; p = .161) in their analysis of 81 patients of SCC penis 15 . Ball et al 16 analyzed 28 patients of SCC penis and reported that LND > 5% independently predicted recurrence‐free survival and OS. Although, LND as a predictor of survival was proved by these authors, there is a lack of consensus about the optimal threshold of LND for predicting survival.…”

Section: Discussionmentioning

confidence: 99%

Log ODDS (LODDS) of positive lymph nodes as a predictor of overall survival in squamous cell carcinoma of the penis

Patel

Salunke

Bhatt

et al. 2021

Journal of Surgical Oncology

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Objective: To evaluate the role of logarithmic ODDS (LODDS) in the number of positive lymph nodes and the number of negative lymph nodes as a prognostic metric in the squamous cell carcinoma (SCC) penis.Methods: Data were retrospectively collected from 96 cases of SCC penis that underwent bilateral groin dissection between 2010 and 2015 at our institute.Lymph node density (LND) and LODDS were calculated for all the patients and classified according to American Joint Committee on Cancer (AJCC) pN staging.Thresholds for LND (24% and 46%) and LODDS (−0.75 and 0) were established.Multivariate analysis of various cofactors was done with overall survival (OS) as a dependent factor. Three classification systems were compared using receiver operative characteristic (ROC) curve analysis.Results: Univariate analysis showed that AJCC pN, LND, and LODDS were all significantly correlated with OS. However, only LODDS (HR, 11.185; p = .023) remained an independent prognostic factor through multivariate analysis. LODDS (log-likelihood = 3832 vs. 3798; p < .001) had better prognostic performance than pN and better discriminatory ability than LND (AIC = 3902 vs. 3928). LODDS had better power of discrimination than LND and pN. LODDS could predict survival in lymph node yield (LNY) < 15 (p < .001). Conclusion:LODDS is an independent predictor of OS in the SCC penis and has superior prognostic significance than the AJCC pN and LND classification systems.

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Section: Discussionmentioning

confidence: 99%

Log ODDS (LODDS) of positive lymph nodes as a predictor of overall survival in squamous cell carcinoma of the penis

Patel

Salunke

Bhatt

et al. 2021

Journal of Surgical Oncology

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“…A few studies have shown LN counts ranging from eight to 16 as prognostic, although limited by low numbers of patients or by inherent limitations of national registries . Other studies have evaluated the role of LN density as more prognostic than the total number of positive LNs removed . Further investigation is warranted to evaluate the prognostic role of LN density and its diagnostic and therapeutic implications.…”

Section: Discussionmentioning

confidence: 99%

Identifying an optimal lymph node yield for penile squamous cell carcinoma: prognostic impact of surgical dissection

et al. 2019

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Objective To evaluate the prognostic impact of lymph node yield (LNY) on survival outcomes for penile squamous cell carcinoma (SCC). Patients and methods In all, 532 patients who underwent inguinal LN dissection (ILND) across tertiary referral centres from Europe, China, Brazil and North America were retrospectively evaluated. From this cohort, 198 patients received pelvic LND (PLND).We identified threshold values for ILND and PLND using receiver operating characteristic curves. We tested prognostic value of LNY for recurrence‐free survival (RFS), disease‐specific survival (DSS), and overall survival (OS) using the Kaplan–Meir method and Cox proportional hazard regression models. Results The median (interquartile [IQR]) age was 59 (49–68) years and the median (IQR) follow‐up after ILND was 28 (12–68.2) months. Overall, 85% of the patients had bilateral dissections. The median (IQR) number of inguinal LNs removed was 15 (10–22). Of those receiving PLND, The median (IQR) number of LNs was 13 (8–19). A LNY of ≥15 was used for dichotomisation of ILND patients, and a LNY of ≥9 was used in the PLND cohort. Patients with a LNY ≥15 had significantly better 5‐year OS vs patients with a LNY <15 (70.1% vs 58.7%). On multivariable analyses, a LNY ≥15 was a predictor of OS (hazard ratio [HR] 0.68, P = 0.029). For cN0 patients, a LNY ≥15 was an independent predictor of RFS (HR 0.52, P = 0.043) and OS (HR 0.53, P = 0.021). In the PLND cohort, a LNY ≥9 was a predictor of RFS (HR 0.53, P = 0.032). Conclusions Using one of the largest LND datasets to date, we found LNY to be a significant predictor of outcomes after lymphatic staging for penile SCC. Prospective validation is warranted.

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“…From the previous studies we have known that examined lymph node (ELN) count and lymph node density (LND) are the percentage of positive LNs, which have been used as a prognostic factor for other tumors, such as esophageal cancer, non-smallcell lung cancer and bladder cancer (2,(10)(11)(12)(13)(14). Unfortunately, these were rarely studied in PeCa.…”

Section: Introductionmentioning

confidence: 99%

Impact of Examined Lymph Node Count and Lymph Node Density on Overall Survival of Penile Cancer

et al. 2021

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BackgroundFew studies have explored the optimal examined lymph node count and lymph node density cutoff values that could be used to predict the survival of patients with penile cancer. We further clarify the prognostic value of lymph node density and examined lymph node count in penile cancer.MethodsThe Surveillance, Epidemiology, and End Results (SEER) database was explored to recruit penile cancer patients from 2010 to 2015. A retrospective analysis of penile cancer patients’ data from the First Affiliated Hospital of Anhui Medical University was performed for verification (2006–2016). The cutoff values of examined lymph node count and lymph node density were performed according to the ROC curve. Kaplan-Meier survival analysis was used to compare survival differences among different groups. Univariate and multivariate Cox proportional hazard regression analyses were used to determine the significant variables. On the basis of Cox proportional hazards regression model, a nomogram was established and validated by calibration plot diagrams and concordance index (C-index).ResultsA total of 528 patients in the Surveillance, Epidemiology, and End Results cohort and 156 patients in the Chinese cohort were included in this study. Using the ROC curve, we found that the recommended cutoff values of ELN and LND were 13 and 9.3%, respectively (P <0.001). Kaplan–Meier curves suggested the significant differences of overall survival among different examined lymph nodes and lymph node density. Multivariate analysis indicated ELN and LND were independent prognostic factor for OS of penile cancer patients. Nomogram showed the contribution of ELN and LND to predicting OS was large. The C-index at 3-, and 5-year were 0.744 for overall survival (95% CI 0.711–0.777).ConclusionsThe more lymph nodes examined, the lower the density of lymph nodes, and the higher the long-term survival rate of penile cancer. We recommended 13 examined lymph nodes and lymph node density >9.3% as the cutoff value for evaluating the prognosis of penile cancer patients.

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Lymph node density predicts recurrence and death after inguinal lymph node dissection for penile cancer

Cited by 17 publications

References 22 publications

Log ODDS (LODDS) of positive lymph nodes as a predictor of overall survival in squamous cell carcinoma of the penis

Log ODDS (LODDS) of positive lymph nodes as a predictor of overall survival in squamous cell carcinoma of the penis

Identifying an optimal lymph node yield for penile squamous cell carcinoma: prognostic impact of surgical dissection

Impact of Examined Lymph Node Count and Lymph Node Density on Overall Survival of Penile Cancer

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