title: Tumor grade improves the prognostic ability of American Joint Committee on Cancer stage in patients with penile carcinoma.
abstract: OBJECTIVE
  Penile cancer is rare. Thus, predicting cancer specific mortality may be difficult. We devised an accurate and yet easily applicable predictive rule that compares favorably with 2 previous models (73.8% and 74.7% accuracy, respectively).
  
  
  METHODS
  We identified patients treated with primary tumor excision for all stages of penile squamous cell carcinoma between 1998 and 2006. Disease stage definitions using Surveillance, Epidemiology and End Results stage, American Joint Committee on Cancer stage and TNM classification, and tumor grade were used to predict cancer specific mortality. Predictive accuracy estimates were compared using the DeLong method for related AUCs.
  
  
  RESULTS
  Surveillance, Epidemiology and End Results stage alone (1 predictor variable) was least accurate (74.5%). American Joint Committee on Cancer stage with tumor grade (2 predictor variables) was the most simple and most accurate (80.9%, p <0.001). A benefit similar to that of American Joint Committee on Cancer stage with tumor grade was seen for TNM classification and TG (80.7%, p = 0.8). However, this rule (4 predictor variables) was more complex than American Joint Committee on Cancer stage and tumor grade.
  
  
  CONCLUSIONS
  American Joint Committee on Cancer stage combined with tumor grade is the simplest, most accurate cancer specific mortality prediction rule after primary tumor excision for penile squamous cell carcinoma. This method is also more accurate than 2 previous cancer specific mortality prediction rules.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thuret
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Lars
authors.initials: L
authors.lastname: Budaus
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.forename: Daniel
authors.initials: D
authors.lastname: Liberman
authors.forename: Monica
authors.initials: M
authors.lastname: Morgan
authors.forename: Rupinder
authors.initials: R
authors.lastname: Johal
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Mathieu
authors.initials: M
authors.lastname: Latour
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: François
authors.initials: F
authors.lastname: Iborra
authors.forename: Jacques
authors.initials: J
authors.lastname: Guiter
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D017408:Guidelines as Topic; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D049451:Nomograms; D010412:Penile Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D035583:Rare Diseases; D018570:Risk Assessment; D018426:SEER Program; D012955:Societies, Medical; D016019:Survival Analysis; D055815:Young Adult