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

Wiley - Tập 38 - Trang 1-10 - 2018
Zai-Shang Li1,2,3,4, Antonio Augusto Ornellas5, Christian Schwentner6, Xiang Li7, Alcides Chaux8, Georges Netto9, Arthur L. Burnett10, Yong Tang11, JiunHung Geng12, Kai Yao2,3,4, Xiao-Feng Chen13, Bin Wang14, Hong Liao15, Nan Liu16, Peng Chen17, Yong-Hong Lei18, Qi-Wu Mi19, Hui-Lan Rao20, Ying-Ming Xiao15, Qi-Lin Wang18, Zi-Ke Qin2,3,4, Zhuo-Wei Liu2,3,4, Yong-Hong Li2,3,4, Zi-Jun Zou7, Jun-Hang Luo21, Hui Li22, Hui Han2,3,4, Fang-Jian Zhou2,3,4
1Department of Urology, Shenzhen People’s Hospital, The Second Clinical College of Jinan University, Shenzhen, P. R. China
2Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China
3Department of Urology, Sun Yat-sen University Cancer Center, East Guangzhou, P. R. China
4Department of Urology, Brazilian National Institute of Cancer and Hospital Mário Kröeff, Rio de Janeiro, Brazil
5Section of Urology, National Institute of Cancer, Rio de Janeiro, Brazil
6Department of Urology, Diakonie Klinikum Stuttgart, Stuttgart, Germany
7Urological Department, Urological Institute, West China Hospital of Sichuan University, Chengdu, P. R. China
8Department of Scientific Research, Norte University, Asunción, Paraguay
9Department of Pathology, Johns Hopkins University, Baltimore, USA
10Department of Urology, Johns Hopkins University, Baltimore, USA
11Department of Urology, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, P. R. China
12Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, China
13Department of Urology, The First People’s Hospital of Chenzhou, Chenzhou, P. R. China
14Department of Urology, Cancer Center of Guangzhou Medical University, Guangzhou, P. R. China
15Department of Urology, Sichuan Cancer Hospital, Chengdu, P. R. China
16Department of Urology Oncological Surgery, Chongqing Cancer Hospital & Institute & Cancer Center, Chongqing, China
17Department of Urology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, P. R. China
18Department of Urology, Yunnan Provincial Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, P. R. China
19Department of Urology, Dongguan People’s Hospital, Dongguan, P. R. China
20Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
21Department of Urology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
22Department of Pathology, The Chinese University of Hong Kong, Hong Kong, P. R. China

Tóm tắt

The 8th American Joint Committee on Cancer tumor–node–metastasis (AJCC-TNM) staging system is based on a few retrospective single-center studies. We aimed to test the prognostic validity of the staging system and to determine whether a modified clinicopathological tumor staging system that includes lymphovascular embolization could increase the accuracy of prognostic prediction for patients with stage T2–3 penile cancer. 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 system. The internal validation was analyzed by bootstrap-corrected C-indexes (resampled 1000 times). Data from 436 patients who were treated at 15 centers over four continents were used for external validation. A survivorship overlap was observed between T2 and T3 patients (P = 0.587) classified according to the 8th AJCC-TNM staging system. Lymphovascular 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 influence 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 lymphovascular 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 invasion. The 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 accuracy in predicting patient prognoses than did the 8th AJCC-TNM staging system (C-index, 0.739 vs. 0.696). These results were confirmed in the external validation cohort. T2–3 penile cancers are heterogeneous, and a modified clinicopathological staging system that incorporates lymphovascular embolization may better predict the prognosis of patients with penile cancer than does the 8th AJCC-TNM staging system. Trial registration This study was retrospectively registered on Chinese Clinical Trail Registry: ChiCTR16008041 (2016-03-02). http://www.chictr.org.cn

Tài liệu tham khảo

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