The Prognostic Ability of Staging System in Men with Penile Cancer: An Analysis of SEER Database

  • Aditya Jalan
  • Ravi Kanodia
  • Sarita Rana Gurung
  • Rajeev Kumar Malhotra
  • Umesh Nepal
  • Gyan Prasad Pokhrel
  • Nirmal Lamichhane
Keywords: Normograms, Penis, Squamous Cell Carcinoma, Survival


Background: Penile cancer is now a rare condition. The low incidence of the disease makes a valid estimation of
its prognosis difficult. In this study, we made an attempt and propose a nomogram to develop a prognostic rule
that could predict the Cancer-Specific Mortality (CSM) free rates in patients with primary penile squamous cell
carcinoma of the penis (PPSCC).
Methods: This study included 1304 patients diagnosed with PPSCC between the years 2004 & 2011 and treated
with penile tumor excision. Subjects were staged as per Surveillance, Epidemiology & End Results stage (SEER),
American Joint Committee on Cancer (AJCC), TNM classification and tumor grade (TG). CSM free rates were
determined. Univariate and multivariate Cox regression model was used to test the prediction of the CSM free
rate. The predictive rule accuracy was created using the receiver operating characteristic curve.
Results: The clinico-pathological profile depicts a mean age of 64.66 ± 14.38 yrs. The most common primary site
involved was glans penis (n= 483, 37%) and the disease was most commonly diagnosed at AJCC stage I (n= 670,
51.4%) disease. The cumulative 5-year CSM free rates according to Fine & Gray, & Kaplan-Meier methods were
81.8% and 79.8%, respectively. The predictive accuracy as per SEER stage, AJCC stage, TNM stage alone were
68.8%, 70.3%, 72.3%, respectively. When TG was combined, the predictive accuracy increased to 72.8%, 73.1%,
and 75.0%, respectively. TNM stage with TG was most accurate in predicting CSM free rate compared to other
Conclusions: TNM stage with TG and AJCC stage with TG appear to have comparable accuracy to predict the CSM
free rate in patients with PPSCC, the TNM stage with TG is the most accurate (75%) method to predict the CSM
free rates. The addition of the TG variable improved the accuracy of these prognostic models.