Patel Keval N, Sharma Mohit, Yalla Poojitha, Aaron Jebin, Salunke Abhijeet, Puj Ketul, Warikoo Vikas, Pal Mahendra, Bakshi Ganesh, Pandya Shashank J
Department of Surgical Oncology, The Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.
Department of Surgical Oncology, The Tata Memorial Hospital, Mumbai, Maharashtra, India.
Ann Surg Oncol. 2025 Feb;32(2):1346-1353. doi: 10.1245/s10434-024-16442-y. Epub 2024 Nov 12.
To evaluate the differential prognosis of PLNM as compared to ENE and postulate a sub-classification of the pN3 stage of carcinoma penis.
A retrospective analysis of prospectively maintained data of all the patients of penile squamous cell carcinoma operated at our institute between Jan 2016 and May 2023 was conducted. LASSO Cox regression was used to select variables affecting OS. Cox multivariate analysis was performed to derive significant factors which were permuted to form probable sub-classifications. The best sub-classification was selected based on Akaike Information Criteria (AIC) and Kaplan Meier analysis.
Seventy three patients were included in the study. ENE (HR: 2.6, p = 0.038) and PLNM (HR: 3.3, p = 0.004) were significantly associated with OS on Cox multivariate analysis using LASSO based variable selection. Four probable sub-classifications were created of which pN3a (only ENE) and pN3b (only PLNM and ENE+PLNM) showed least AIC (235.065). The mean OS was 36.6 and 17.2 months respectively for pN3a and pN3b subgroups.
ENE had a better OS as compared to PLNM and ENE+PLNM in our study. A sub-classification of pN3 stage of TNM classification is proposed. Multi-institutional prospective studies with large number of patients and longer follow-up should validate our findings.
评估与包膜外侵犯（ENE）相比，盆腔淋巴结转移（PLNM）的不同预后，并对阴茎癌pN3期进行亚分类。
对2016年1月至2023年5月在我院接受手术的所有阴茎鳞状细胞癌患者的前瞻性维护数据进行回顾性分析。使用套索（LASSO）Cox回归选择影响总生存期（OS）的变量。进行Cox多变量分析以得出显著因素，并对这些因素进行排列以形成可能的亚分类。根据赤池信息准则（AIC）和Kaplan-Meier分析选择最佳亚分类。
73例患者纳入研究。在使用基于LASSO的变量选择进行的Cox多变量分析中，ENE（风险比：2.6，p = 0.038）和PLNM（风险比：3.3，p = 0.004）与OS显著相关。创建了四个可能的亚分类，其中pN3a（仅ENE）和pN3b（仅PLNM以及ENE + PLNM）显示出最小的AIC（235.065）。pN3a和pN3b亚组的平均OS分别为36.6个月和17.2个月。
在我们的研究中，ENE与PLNM和ENE + PLNM相比具有更好的总生存期。提出了TNM分类中pN3期的亚分类。需要大量患者且随访时间更长的多机构前瞻性研究来验证我们的发现。
