Comparison of three lymph node indicators in predicting prognosis of squamous cell carcinoma of the penis
Objective To investigate the predictive value of number of metastatic lymph nodes(NMLN),lymph node ratio(LNR),and log odds of positive lymph nodes(LODDS)on the prognosis of patients with squamous cell carcinoma of the penis(SCCP).Methods The data from patients diagnosed with SCCP and who underwent lymph node dissection between 2004 and 2019 from the SEER database were selected as study objects.After excluding cases with missing values,a total of 781 patients with a mean age of 61.46±12.73 years were finally included in the study.According to the 2017 AJCC penile cancer tumor node metastasis(TNM)staging system,study objects were classified into NMLN stage Ⅰ,Ⅱ,and Ⅲ;the cut-off values for LNR and LODDS were determined using X-tile software,and patients were classified into LNR stageⅠ,Ⅱ,and Ⅲ and LODDS stage Ⅰ,Ⅱ,and Ⅲ.Kaplan-Meier curves were plotted and Log-rank tests were used to compare differences between groups.Variables with statistically significant differences identified from univariate analysis were included as covariates and separately incorporated into Cox proportional hazards models for NMLN staging,LNR staging,and LODDS staging,followed by model evaluation.Subgroup analyses were conducted according to the presence or absence of extranodal extension(ENE)or pelvic lymph node metastasis.Results Log-rank tests revealed statistically significant differences in cancer-specific survival(CSS)among patients in NMLN staging(x2=97.964,P＜0.001),LNR staging(x2=187.786,P＜0.001),and LODDS staging(x2=183.486,P＜0.001).Univariate analysis showed that age,differentiation degree,T stage,M stage,NMLN stage,LNR stage,and LODDS stage were factors affecting CSS in SCCP patients(P＜0.05).Multivariate analysis indicated that NMLN staging,LNR staging,and LODDS staging were independent prognostic factors for CSS in SCCP patients(P＜0.05).The model evaluation shows no significant difference in accuracy and goodness of fit between Cox regression models using LNR staging and LODDS staging.Additionally,both models perform better than the model using NMLN staging.Subgroup analysis revealed that in the subgroup with ENE or pelvic lymph node metastasis,LNR staging and LODDS staging were independent prognostic factors for CSS in SCCP patients(P＜0.05),while NMLN staging was not(P＞0.05);the C-index of the Cox regression model incorporating NMLN staging was less than 0.7,indicating poor accuracy,and the model's accuracy and goodness-of-fit were inferior to those incorporating LNR staging and LODDS staging.Conclusions LNR and LODDS show superior predictive ability for the prognosis of patients with SCCP.They also demonstrate predictive capacity in SCCP patients with ENE or pelvic lymph node metastasis.
Carcinoma of the penisPrognosisLymph node indicatorsSurvival analysis
NETL
NSTL
万方数据
