Relationship between lymph node ratio and cancer-specific survival in a contemporary series of patients with penile cancer and lymph node metastases

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Abstract

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. We considered LNR both as a continuously coded and as a categorically coded variable. The minimum-P-value approach was used to determine the most significant LNR threshold. The Kaplan-Meier method was used to determine CSS rates, and univariable and multivariable Cox regression models were fitted to test the predictors of CSS. Results The median (interquartile range [IQR]) numbers of positive and removed lymph nodes were 2 (1-4) and 22 (13-30), respectively. The median (IQR) LNR was 10.3 (6.3-16.6)% and the most significant LNR threshold was 22%. The median (IQR) follow-up was 26 (16-62) months. Overall, the 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 <22% vs LNR ≥ 22%, respectively (P <0.001). In multivariable Cox regression models, after adjusting for several established prognostic factors, LNR was as independent predictor of CSS (P≤0.012). Finally, LNR significantly improved the accuracy of multivariable Cox regression models by 4.9-10.5%. Conclusions Although further investigations are needed to evaluate the relationship between tumour burden and treatment intensity, LNR may represent a powerful predictor of CSS in patients with penile cancer and pathologically determined LNM.

Original languageEnglish
Pages (from-to)727-733
Number of pages7
JournalBJU International
Volume116
Issue number5
DOIs
Publication statusPublished - Nov 1 2015

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Penile Neoplasms
Lymph Nodes
Neoplasm Metastasis
Survival
Neoplasms
Proportional Hazards Models
Survival Rate

Keywords

  • cancer-specific survival
  • lymph node ratio
  • lymph nodes
  • penile cancer
  • pN stage
  • prognosis

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

@article{8edb7aa92458421b8277da031962a95b,
title = "Relationship between lymph node ratio and cancer-specific survival in a contemporary series of patients with penile cancer and lymph node metastases",
abstract = "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. We considered LNR both as a continuously coded and as a categorically coded variable. The minimum-P-value approach was used to determine the most significant LNR threshold. The Kaplan-Meier method was used to determine CSS rates, and univariable and multivariable Cox regression models were fitted to test the predictors of CSS. Results The median (interquartile range [IQR]) numbers of positive and removed lymph nodes were 2 (1-4) and 22 (13-30), respectively. The median (IQR) LNR was 10.3 (6.3-16.6){\%} and the most significant LNR threshold was 22{\%}. The median (IQR) follow-up was 26 (16-62) months. Overall, the 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 <22{\%} vs LNR ≥ 22{\%}, respectively (P <0.001). In multivariable Cox regression models, after adjusting for several established prognostic factors, LNR was as independent predictor of CSS (P≤0.012). Finally, LNR significantly improved the accuracy of multivariable Cox regression models by 4.9-10.5{\%}. Conclusions Although further investigations are needed to evaluate the relationship between tumour burden and treatment intensity, LNR may represent a powerful predictor of CSS in patients with penile cancer and pathologically determined LNM.",
keywords = "cancer-specific survival, lymph node ratio, lymph nodes, penile cancer, pN stage, prognosis",
author = "Giovanni Lughezzani and Mario Catanzaro and Tullio Torelli and Luigi Piva and Davide Biasoni and Silvia Stagni and Andrea Necchi and Patrizia Giannatempo and Daniele Raggi and Elena Fare' and Maurizio Colecchia and Giorgio Pizzocaro and Roberto Salvioni and Nicola Nicolai",
year = "2015",
month = "11",
day = "1",
doi = "10.1111/bju.12510",
language = "English",
volume = "116",
pages = "727--733",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "5",

}

TY - JOUR

T1 - Relationship between lymph node ratio and cancer-specific survival in a contemporary series of patients with penile cancer and lymph node metastases

AU - Lughezzani, Giovanni

AU - Catanzaro, Mario

AU - Torelli, Tullio

AU - Piva, Luigi

AU - Biasoni, Davide

AU - Stagni, Silvia

AU - Necchi, Andrea

AU - Giannatempo, Patrizia

AU - Raggi, Daniele

AU - Fare', Elena

AU - Colecchia, Maurizio

AU - Pizzocaro, Giorgio

AU - Salvioni, Roberto

AU - Nicolai, Nicola

PY - 2015/11/1

Y1 - 2015/11/1

N2 - 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. We considered LNR both as a continuously coded and as a categorically coded variable. The minimum-P-value approach was used to determine the most significant LNR threshold. The Kaplan-Meier method was used to determine CSS rates, and univariable and multivariable Cox regression models were fitted to test the predictors of CSS. Results The median (interquartile range [IQR]) numbers of positive and removed lymph nodes were 2 (1-4) and 22 (13-30), respectively. The median (IQR) LNR was 10.3 (6.3-16.6)% and the most significant LNR threshold was 22%. The median (IQR) follow-up was 26 (16-62) months. Overall, the 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 <22% vs LNR ≥ 22%, respectively (P <0.001). In multivariable Cox regression models, after adjusting for several established prognostic factors, LNR was as independent predictor of CSS (P≤0.012). Finally, LNR significantly improved the accuracy of multivariable Cox regression models by 4.9-10.5%. Conclusions Although further investigations are needed to evaluate the relationship between tumour burden and treatment intensity, LNR may represent a powerful predictor of CSS in patients with penile cancer and pathologically determined LNM.

AB - 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. We considered LNR both as a continuously coded and as a categorically coded variable. The minimum-P-value approach was used to determine the most significant LNR threshold. The Kaplan-Meier method was used to determine CSS rates, and univariable and multivariable Cox regression models were fitted to test the predictors of CSS. Results The median (interquartile range [IQR]) numbers of positive and removed lymph nodes were 2 (1-4) and 22 (13-30), respectively. The median (IQR) LNR was 10.3 (6.3-16.6)% and the most significant LNR threshold was 22%. The median (IQR) follow-up was 26 (16-62) months. Overall, the 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 <22% vs LNR ≥ 22%, respectively (P <0.001). In multivariable Cox regression models, after adjusting for several established prognostic factors, LNR was as independent predictor of CSS (P≤0.012). Finally, LNR significantly improved the accuracy of multivariable Cox regression models by 4.9-10.5%. Conclusions Although further investigations are needed to evaluate the relationship between tumour burden and treatment intensity, LNR may represent a powerful predictor of CSS in patients with penile cancer and pathologically determined LNM.

KW - cancer-specific survival

KW - lymph node ratio

KW - lymph nodes

KW - penile cancer

KW - pN stage

KW - prognosis

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U2 - 10.1111/bju.12510

DO - 10.1111/bju.12510

M3 - Article

VL - 116

SP - 727

EP - 733

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 5

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