title: Evaluation of current TNM classification of penile carcinoma.
abstract: OBJECTIVE
  The TNM classification is the most common tool for staging malignancies. The current classification for penile carcinoma has been unchanged since 1987. There are several shortcomings to this classification. Accurate clinical staging can be troublesome because several categories are defined by anatomical structures that cannot readily be identified by physical examination or imaging. A second drawback is substantial variability with respect to survival in certain T and N categories. We analyzed the prognostic value of the TNM classification in patients with penile carcinoma treated at our institute. We propose modifications to improve prognostic stratification and facilitate clinical staging.
  
  
  METHODS
  The records of 513 patients treated between 1956 and 2006 were analyzed. All tumors were staged according to the most recent classification. We calculated disease specific survival in the different T and N categories. Survival in the different categories was compared using Kaplan-Meier analysis and the log rank test.
  
  
  RESULTS
  Five-year disease specific survival in the entire group was 80.5% at a median followup of 58.7 months. There was no significant difference in survival between T2 and T3 tumors (p = 0.57). Furthermore, no significant survival difference was found between N1 and N2 categories (p = 0.18). Using a modified classification a significant difference in survival was found among all T and N categories.
  
  
  CONCLUSIONS
  The current TNM classification for penile carcinoma does not adequately differentiate in terms of survival among several T and N categories. With some modifications prognostic stratification improves and clinical staging is facilitated.
authors.affiliation: Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Joost A P
authors.initials: JA
authors.lastname: Leijte
authors.forename: Maarten
authors.initials: M
authors.lastname: Gallee
authors.forename: Ninja
authors.initials: N
authors.lastname: Antonini
authors.forename: Simon
authors.initials: S
authors.lastname: Horenblas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D016019:Survival Analysis