Currently, no standardized predictive model is widely adopted in clinical practice for assessing outcome and lymph node metastasis (LNM). This study aimed at predicting inguinal lymph node involvement and mortality in patients suffering penile squamous cell carcinoma (PSCC) by developing a simple and clinically applicable scoring system.
Clinical and histopathological data from 11 centers, collected between 2000 and 2021, were reclassified (the Eighth Edition of the AJCC Cancer Staging Manual). Data from 8 centers (517 patients) were randomized into training and internal validation cohorts (7:3), and data from the remaining 3 centers contributed 201 patients for external validation. A dual-outcome prediction model was established with univariate and multivariate logistic regression for LNM prediction, and Cox regression for outcome assessment. Kaplan-Meier curves were drawn to estimate the disease-specific survival (DSS), alongside the log-rank test conducted on the difference in survival. Model performance was evaluated through the AUC, calibration plots, Hosmer-Lemeshow goodness-of-fit test, along with decision curve analysis (DCA).
The study enrolled 718 patients with penile cancer aged at 55 years (IQR: 46-65). Perineural invasion (PNI), lymphovascular invasion (LVI), tumor grade and T stage were independently associated with both LNM and survival (all P < 0.05). For LNM prediction, the scoring system achieved AUCs of 0.80 (95% CI: 0.75-0.84), 0.79 (95% CI: 0.72-0.86) and 0.76 (95% CI: 0.68-0.83) in the training, internal validation, and external validation cohorts, respectively. For 3-year DSS prediction, the time-dependent AUCs were 0.86 (95% CI: 0.81-0.91), 0.84 (95% CI: 0.75-0.92), and 0.87 (95% CI: 0.79-0.94) in respective cohorts. The scoring system was adopted to categorize patients into different risk groups for both LNM and 3-year DSS (Log-rank P < 0.05). Calibration plots revealed a strong consistency between predicted and actual probabilities for both LNM and 3-year DSS across all cohorts. DCA confirmed the favorable predictive accuracy of the scoring system for both inguinal lymph node involvement and mortality in PSCC.
This simple scoring system demonstrates robust predictive accuracy for inguinal LNM and DSS in PSCC, which practically benefits the risk stratification and personalized management decisions in penile cancer care.
Urologic oncology. 2026 Mar 14 [Epub ahead of print]
Yepeng Guo, Zijian Cai, Antonio Augusto Ornellas, Christian Schwentner, Jiun-Hung Geng, Desi Chen, Gaowei Huang, Bonan Chen, Xueqi Zhang, Xin Jiang, Jingjin Liu, Yumeng Tang, Zhaohui Chen, Zaishang Li
Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China., Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China; Department of Urology, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University) Shenzhen, China; Guangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics, Department of Urology, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University), Shenzhen, China., Department of Urology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Department of Urology, Hospital Mario Kröeff, Rio de Janeiro, Brazil., Department of Urology, Diakonie Klinikum Stuttgart, Stuttgart, Germany., Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, China., Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Sir Y.K. Pao Cancer Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China; CUHK-Shenzhen Research Institute, Shenzhen, China., Guangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics, Department of Geriatrics, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University), Shenzhen, China., Department of Nephrology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China., Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China; Department of Urology, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University) Shenzhen, China; Guangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics, Department of Urology, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University), Shenzhen, China. Electronic address: ., Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China; Department of Urology, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University) Shenzhen, China; Guangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics, Department of Urology, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University), Shenzhen, China. Electronic address: .