机构：[1]Department of Urology, Shenzhen People’s Hospital, The Second Clinical College of Jinan University, Shenzhen 518060, Guangdong, P. R. China.深圳市康宁医院深圳市人民医院深圳医学信息中心[2]Sun Yat-sen University Cancer Center.State Key Laboratory of Oncology in South China.Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, Guangdong, P. R. China.[3]Department of Urology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East Guangzhou 510060, Guangdong, P. R. China.[4]Department of Urology, Brazilian National Institute of Cancer and Hospital Mário Kroeff, Rio de Janeiro 20230‑130, Brazil.[5]Section of Urology, National Institute of Cancer, Rio de Janeiro, Brazil.[6]Department of Urology, Diakonie Klinikum Stuttgart, 70174 Stuttgart, Germany.[7]Urological Department, Urological Institute, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P. R. China.四川大学华西医院[8]Department of Scientific Research, Norte University, 1001‑1925 Asunción, Paraguay.[9]Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA.[10]Department of Urology, Johns Hopkins University, Baltimore, MD 21218, USA.[11]Department of Urology, Affiliated Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, P. R. China.[12]Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 807, China.[13]Department of Urology, The First People’s Hospital of Chenzhou, Chenzhou 423000, Hunan, P. R. China.[14]Department of Urology, Cancer Center of Guangzhou Medical University, Guangzhou 510000, Guangdong, P. R. China.[15]Department of Urology, Sichuan Cancer Hospital, Chengdu 610041, Sichuan, P. R. China.四川省肿瘤医院[16]Department of Urology Oncological Surgery, Chongqing Cancer Hospital & Institute & Cancer Center, Chongqing 400040, China.[17]Department of Urology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, P. R. China.[18]Department of Urology, Yunnan Provincial Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan, P. R. China.[19]Department of Urology, Dongguan People’s Hospital, Dongguan 523059, Guangdong, P. R. China.[20]Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.[21]Department of Urology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong, P. R. China.中山大学附属第一医院[22]Department of Pathology, The Chinese University of Hong Kong, Hong Kong 999077, P. R. China.
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
基金：
Research reported in this publication was supported by the Science and
Technology Planning Project of Guangdong Province, China (Grant No.
2015A030302018).
第一作者机构：[1]Department of Urology, Shenzhen People’s Hospital, The Second Clinical College of Jinan University, Shenzhen 518060, Guangdong, P. R. China.[2]Sun Yat-sen University Cancer Center.State Key Laboratory of Oncology in South China.Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, Guangdong, P. R. China.[3]Department of Urology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East Guangzhou 510060, Guangdong, P. R. China.[4]Department of Urology, Brazilian National Institute of Cancer and Hospital Mário Kroeff, Rio de Janeiro 20230‑130, Brazil.
共同第一作者：
通讯作者：
通讯机构：[2]Sun Yat-sen University Cancer Center.State Key Laboratory of Oncology in South China.Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, Guangdong, P. R. China.[3]Department of Urology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East Guangzhou 510060, Guangdong, P. R. China.[4]Department of Urology, Brazilian National Institute of Cancer and Hospital Mário Kroeff, Rio de Janeiro 20230‑130, Brazil.
推荐引用方式(GB/T 7714)：
Zai‑Shang Li,Antonio Augusto Ornellas,Christian Schwentner,et al.A modified clinicopathological tumor staging system for survival prediction of patients with penile cancer[J].CANCER COMMUNICATIONS.2018,38:doi:10.1186/s40880-018-0340-x.
APA：
Zai‑Shang Li,Antonio Augusto Ornellas,Christian Schwentner,Xiang Li,Alcides Chaux...&Fang‑Jian Zhou.(2018).A modified clinicopathological tumor staging system for survival prediction of patients with penile cancer.CANCER COMMUNICATIONS,38,
MLA：
Zai‑Shang Li,et al."A modified clinicopathological tumor staging system for survival prediction of patients with penile cancer".CANCER COMMUNICATIONS 38.(2018)
