Individualized prediction of the risk of inguinal lymph node metastasis in patients with squamous cell carcinoma of penile

Q4 Medicine

中华泌尿外科杂志 Pub Date : 2019-12-15 DOI:10.3760/CMA.J.ISSN.1000-6702.2019.12.007

G. Hou, Yu Zheng, Fuli Wang, Xi’an Li, Geng Zhang, Longlong Zhang, Wanxiang Zheng

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引用次数: 0

Abstract

Objective To investigate the independent predictors of inguinal lymph node metastasis (LLM) in patients with penile squamous cell carcinoma (SCCP), and to establish a nomogram for predicting individual LLM risk. Methods The data of patients with SCCP diagnosed at the department of urology, Xijing Hospital from July 2009 to June 2019 were analyzed retrospectively. A total of 101 patients were included in this study, with age of 55 (26-84) years. There were 25 (24.8%) and 76 (75.2%) patients with and without palpable inguinal lymph node enlargement, respectively. There were 47 cases (46.5%), 40 cases (39.6%) and 14 cases (13.9%) in T1, T2 and T3 stages, respectively; there were 67 cases (66.3%), 21 cases (20.8%) and 13 cases (12.9%) in Broder 1, 2 and 3, respectively. The average value (or median) of fibrinogen was 2.84 (1.72-5.00)g/L; alkaline phosphatase was 80(32±214)U, hemoglobin was 147(81-180)g, platelet count was (193.74±65.68×109/L, absolute value of neutrophils, monocytes and lymphocytes were 3.98(1.19-11.85)×109/L, 0.44(0.17-1.90)×109/L and 1.68(0.58-4.13)×109/L, respectively. The average (or median) value of PLR, NLR and LMR were 113.38(18.80-418.42), 2.42(0.59-10.22) and 3.84 (1.08-9.89), respectively. There were 26 cases (25.7%) with LLM and 75 cases (74.3%) without LLM. The independent predictors of LLM were identified by univariate and multivariate logistic regression analyses. The R software was used to establish the nomogram by integrating all independent predictors, and the bootstrap method was used to internally validated our nomogram, where the value of AUC (area under the ROC curve) was calculated and the calibration plot was drawn. Results Clinical inguinal lymph node status (P<0.006), T stage (P<0.021), Broder grade (P<0.017) and absolute neutrophil value (P<0.043) were independent predictors of LLM. The accuracy of our nomogram was 0.875 (AUC=0.875, 95%CI 0.859-0.891); Moreover, the risk of LLM predicted by nomogram was in good consistency with the actual LLM rate, and the errors of the nomogram-predicted LLM risks were all within 10%. Conclusions Clinical inguinal lymph node status, T stage, broder grade and absolute value of neutrophils were identified as independent predictors of LLM in patients with SCCP on the basis of single center data. A generic nomogram predicting LLM risk for Chinese patients was developed, which would be helpful to screen SCCP patients who need prophylactic inguinal lymph node dissection. Key words: Penile neoplasms; Squamous cell carcinoma; Inguinal lymph node metastasis; Nomogram

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阴茎鳞癌患者腹股沟淋巴结转移风险的个体化预测

目的探讨阴茎鳞状细胞癌(SCCP)患者腹股沟淋巴结转移(LLM)的独立预测因素，建立预测个体LLM风险的nomogram。方法回顾性分析西京医院泌尿外科2009年7月至2019年6月诊断为SCCP的患者资料。本研究共纳入101例患者，年龄为55(26-84)岁。可触及腹股沟淋巴结肿大25例(24.8%)，未触及腹股沟淋巴结肿大76例(75.2%)。T1期47例(46.5%)，T2期40例(39.6%)，T3期14例(13.9%);布罗德1号、2号和3号分别有67例(66.3%)、21例(20.8%)和13例(12.9%)。纤维蛋白原平均值(或中位数)为2.84 (1.72 ~ 5.00)g/L;碱性磷酸酶80(32±214)U，血红蛋白147(81 ~ 180)g，血小板计数(193.74±65.68×109/L，中性粒细胞、单核细胞和淋巴细胞绝对值分别为3.98(1.19 ~ 11.85)×109/L、0.44(0.17 ~ 1.90)×109/L和1.68(0.58 ~ 4.13)×109/L。PLR、NLR和LMR的平均值(或中位数)分别为113.38(18.80 ~ 418.42)、2.42(0.59 ~ 10.22)和3.84(1.08 ~ 9.89)。有LLM 26例(25.7%)，无LLM 75例(74.3%)。通过单因素和多因素logistic回归分析确定LLM的独立预测因子。利用R软件对所有独立预测因子进行积分建立nomogram，并采用bootstrap方法对nomogram进行内部验证，计算AUC (ROC曲线下面积)值，绘制校正图。结果临床腹股沟淋巴结状态(P<0.006)、T分期(P<0.021)、Broder分级(P<0.017)、绝对中性粒细胞值(P<0.043)是LLM的独立预测因子。nomogram准确率为0.875 (AUC=0.875, 95%CI 0.859-0.891);此外，nomogram预测LLM的风险与LLM的实际发生率具有较好的一致性，nomogram预测LLM风险的误差均在10%以内。结论在单中心数据的基础上，临床腹股沟淋巴结状态、T分期、中性粒细胞的广义分级和绝对值是SCCP患者LLM的独立预测因素。我们建立了预测中国患者LLM风险的通用nomogram，该nomogram有助于筛选需要预防性腹股沟淋巴结清扫术的SCCP患者。关键词:阴茎肿瘤;鳞状细胞癌;腹股沟淋巴结转移;列线图

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来源期刊

中华泌尿外科杂志 Medicine-Nephrology

CiteScore

0.10

自引率

0.00%

发文量

14180

期刊介绍： Chinese Journal of Urology (monthly) was founded in 1980. It is a publicly issued academic journal supervised by the China Association for Science and Technology and sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. This journal mainly reports on the latest scientific research results and clinical diagnosis and treatment experience in the professional field of urology at home and abroad, as well as basic theoretical research results closely related to clinical practice. The journal has columns such as treatises, abstracts of treatises, experimental studies, case reports, experience exchanges, reviews, reviews, lectures, etc. Chinese Journal of Urology has been included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences), CSCD Chinese Science Citation Database Source Journal (including extended version), and also included in American Chemical Abstracts (CA). The journal has been rated as a quality journal by the Association for Science and Technology and as an excellent journal by the Chinese Medical Association.