Nomograms

Nomograms are mathematical predictive models integrating prognostic information arising from the main clinical and/or pathological variables, thus improving their prognostic accuracy. The first nomograms concerning penile cancer were published by Ficarra and Kattan in 2006. Three nomograms were published with the aim of predicting inguinal lymph node involvement44 and 5-year cancer-specific survival of penile cancer patients.45 More recently, Baghat et al. proposed a similar nomogram again with a view to predicting the probability of positive lymph nodes.46

The Ficarra nomogram44 was generated to predict lymph node involvement in penile cancer patients, integrating data from eight different clinical and pathological variables (clinical inguinal lymph node stage, pathological tumor thickness, growth pattern, histological grade, lymphatic and/or venous embolization, corpora cavernosa infiltration, corpus spongiosum, and/or urethral infiltration) (Fig. 10.54 . This integrated staging system demonstrated excellent prognostic accuracy, with an AUC of the ROC curves of 0.876 and good calibration.44 Although, the use of this nomogram in clinical practice is potentially limited by the lack of external validation, the panel of international consultation on penile cancer proposed to use it to stratify patients with penile cancer in three different risk groups. The low-risk category includes patients who have a probability of positive nodes of 0--10%; the intermediate-risk category includes cases with a probability of involved nodes ranging between 11% and 50% and the high-risk group includes cases with a probability greater than 50%. The international consultation on penile cancer recommended a different management of inguinal lymph nodes according to this risk-group stratification.47

In 2006, Kattan et al. proposed two nomograms which were able to estimate 5-year cancer-specific survival in penile cancer patients.45 In the first model, the 5-year cancer-specific survival probabilities were estimated according to clinical stage of the inguinal lymph nodes and the pathological findings of the primary tumor after partial or total penectomy (tumor thickness, growth pattern, grade, venous and/or lymphatic embolization, corpora cavernosa infiltration, corpus spongiosum

Points

Tumor thickness Growth pattern Grade

Lymphatic and/or vascular embolization

Corpora cavernosa infiltration

Corpus spongiosum infiltration

10 20 30 40 50 60 70

</-5mm vertical grade 1

absent absent absent

Urethra infiltration absent

Clinical lymph node stage cNo_ Total Points

Probability positive nodes superficial grade 3

grade 2

present present present cN+

90 100

present

0.02 0.05 0.1 0.2 0.30.40.50.60.7 0.8 0.9 0.94 0.97 0.9

Fig. 10.5 Ficarra nomogram predicting the probability of inguinal lymph node metastases infiltration, and urethra infiltration). The concordance index of this first model was 0.728. This model, which also showed good calibration, may be used to estimate survival probabilities after surgery for the primary tumor, regardless of locore-gional lymph node management (Fig. 10.6). In the second model, the 5-year cancer-specific survival probabilities were estimated according to the pathological findings of the primary tumor after partial or total penectomy and the pathological stage of inguinal lymph nodes after lymphadenectomy. This model may be useful for patients undergoing either inguinal lymphadenectomy (pN0/pN+) or watchful waiting (NX) to plan the most appropriate follow-up schedule and to identify patients who need adjuvant therapy to improve their outcome (Fig. 10.7).45

In 2009, Baghat et al. proposed a new nomogram to predict the probability of positive lymph nodes using only four parameters: age of patients at diagnosis, clinical inguinal lymph node status, histologic grade, and absence or presence of lymphovas-cular invasion (Fig. 10.8).46 This nomogram could be considered both as a simplified version and as the first external validation of the Ficarra nomogram. The authors reported a concordance index of 0.74 significantly inferior to those reported by Ficarra et al. in the first nomogram predicting lymph node involvement in penile cancer.

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Post a comment