Penile Cancer Prognostic Index

In 2009 Chaux et al. proposed a new integrated pathological tool to predict lymph node involvement and survival in patients with penile SCC. This system included

Points

Tumor thickness Growth pattern Grade

Lymphatic and/or Vascular embolization

10 20 30 40 50 60 70 80 90 100

absent

Corpora cavernosa infiltration absent Corpus spongiosum infiltration absent

Urethra infiltration Clinical lymph node stage

Total Points

5-Yr survival probability absent cN0

superficial grade 2

grade 3

present present present cN+

present

50 100 150 200 250 300 350 400 450 500

Fig. 10.6 Kattan Nomogram predicting 5-year cancer-specific survival according to pathological findings of primary tumor and clinical stage of lymph nodes

20 30

50 60

Points

Tumor thickness Growth pattern Grade

Lymphatic and/or

Vascular embolization absent

>5 mm superficial vertical grade 2

grade1

grade 3

present present

Corpora cavernosa infiltration

Corpus spongiosum infiltration

Urethra infiltration

Pathological lymph node stage

Total Points

5-Yr survival probability absent present absent present absent pNo

90 100

0.98 0.96 0.93 0.9 0.86 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.04 0.01

Fig. 10.7 Kattan Nomogram predicting 5-year cancer-specific survival according to pathological findings of primary tumor and pathological stage of lymph nodes

0 10 20 30 40 50 60 70 80 90 100 Points 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Negative

Positive

GRADE

Negative

Positive

2and3

Total points

100 150 200 250

300 350

Probability of positive lymph node

Fig. 10.8 Bhagat nomogram predicting the probability of positive lymph node according to clinical lymph nodes status, presence of lymphatic or venous embolization, grading and age of the patients (With kind permission from Springer Science + Business Media57)

histological grade (grade 1: 1 point; grade 2: 2 points; grade 3: 3 points), perineural invasion (absent: 0 points; present: 1 point), and anatomical level of infiltration. This last parameter considered the infiltration of lamina propria (level 1: 1 point), corpus spongiosum/dartos (level 2: 2 points), and corpus cavernosum/preputial skin (level 3: 3 points). The index significantly correlated to tumor thickness, perineural invasion, and vascular invasion but not to the presence of urethral invasion. Interestingly, the prognostic index score significantly correlated with the percentage of inguinal nodal metastases. Specifically, patients with score 2-4 had a 0-20% risk of lymph node involvement, while patients with score 5-7 showed a 50-79% risk of nodal metastases. Similarly, using survival analysis data, the Prognostic Index allows one to distinguish between three different groups with good (index 2-4), intermediate (index 5-6), and poor (index 7) prognoses.33 The concordance index of this index was not reported by the authors and therefore it is not possible to compare the prognostic accuracy of this tool with those calculated for previous nomograms.

Table 10.3 shows the included variables and the prognostic accuracy of different available integrated systems.

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