How accurate are present risk group assignment tools in penile cancer?
OBJECTIVE
To evaluate the accuracy of the predictive models available to estimate the risk of lymph node metastases and cancer-specific survival in patients with squamous cell carcinoma of the penis.


METHODS
A nonsystematic review of the literature was performed searching MEDLINE in January 2008.


RESULTS
Most of the authors select patients for early inguinal lymphadenectomy according to the pathologic extension of the primary tumor and its histologic grade, as recommended by the EAU Guidelines and the Solsona risk groups. Although the Solsona risk groups performed slightly better, both risk groups had low predictive accuracy. A nomogram including eight clinical and pathologic variables (tumor thickness, microscopic growth pattern, Broder's grade, presence of vascular or lymphatic embolization, infiltrations of the corpora cavernosa, corpus spongiosum or urethra, and the clinical stage of groin lymph nodes) was developed to estimate the risk of lymph node involvement at follow-up. Two nomograms are currently available able to estimate the 5-year cancer-specific survival probabilities of the patients. The first nomogram included the clinical lymph node stage and the same pathological variables of the primary tumor at penectomy, while the pathological stage of the lymph nodes replaced the clinical one in the second model. All the 3 nomograms had good prognostic accuracy.


CONCLUSIONS
Both the Solsona and EAU risk group assessment had low prognostic accuracy, although the Solsona risk groups performed slightly better. The nomograms designed to predict the risk of lymph node metastases showed and cancer-specific survival had good prognostic accuracy but their external validation is still lacking.
Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Via Giustinioani 2, 35100, Padua, Italy. vincenzo.ficarra@unipd.it
Vincenzo
V
Ficarra
G
G
Novara
R
R
Boscolo-Berto
W
W
Artibani
M W
MW
Kattan
D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D010412:Penile Neoplasms / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D015996:Survival Rate