Squamous cell carcinoma of the penis. IV. Prognostic factors of survival: analysis of tumor, nodes and metastasis classification system.

Various prognostic factors of survival were assessed in 118 patients with squamous cell carcinoma of the penis treated at The Netherlands Cancer Institute between 1956 and 1989. Using the clinical parameters of the tumor, nodes and metastasis classification system of the International Union Against Cancer (1978 version) and a differentiation system consisting of 3 grades the prognostic relevance for survival was analyzed. T category, N category and grade of differentiation showed statistical significance in the univariate analysis. Patients with small tumors, clinically negative nodes and well differentiated tumors showed a favorable prognosis. Only N category and grade were independent prognostic factors of survival using the Cox proportional hazards model. On the basis of the survival analysis a stage grouping consisting of 3 stages is proposed with 5-year survival probabilities for stages 1, 2 and 3 of 93%, 55% and 30%, respectively. A revised version of the tumor, nodes and metastasis system was introduced in 1987. This latest version was analyzed with the previous method, which was used in this report, and prognostically important and clinically useful parameters, such as the size of the primary tumor and evidence of fixation of the regional lymph nodes, have been discarded. The changes in the revised version seem to have little relevance to clinical staging. The revised version should be considered a histopathological classification only.