A cohort study among 402 patients with penile cancer in Maranhão, Northeast Brazil with the highest worldwide incidence

Development and validation of a predictive model for penile cancer based on the surveillance, epidemiology, and end results database and multi-center cases

PURPOSE

Penile cancer (PC) is a great impact on the quality of life and psychological status of patients. This study aimed to construct nomograms using data from the Surveillance, Epidemiology, and End Results (SEER) database to predict overall survival (OS) and cancer-specific survival (CSS) in patients with penile cancer (PC).

METHODS

Patients were divided into a training cohort (n = 634) and a validation cohort (n = 272) in a 7:3 ratio. Independent risk factors influencing the prognosis of PC were screened using univariate and multivariate Cox analyses, and models for predicting PC were developed. Data from 203 patients with PC in four tertiary hospitals in Gansu Province from 2012 to 2021 were externally validated.

RESULTS

Univariate analysis and multivariate analysis showed revealed that the OS-related factors were age, grade, T stage, N stage, M stage and tumor size (p < 0.05); the CSS-related factors were age, mode of surgery, T stage, N stage, M stage and tumor size (p < 0.05). The C-indices of the OS and CSS nomograms in the training cohort were 0.743 [95% confidence interval (CI) (0.714-0.772)] and 0.797 (0.762-0.832), respectively. The C-indices of the OS and CSS nomograms in the internal validation cohort were 0.735 (0.686-0.784) and 0.755 (0.688-0.822), respectively, and those in the external validation cohort were 0.801 (0.746-0.856) and 0.863 (0.812-0.914), respectively. Receiver operating characteristic (ROC) curves, calibration curves, and survival curves all demonstrated good predictive performance of the nomograms.

CONCLUSION

The nomograms for PC were developed using the SEER database. The accuracy and clinical usefulness of the model were validated through a combination of internal and external validations.

The distribution of the clinical variables in a population of adult males circumcised for phimosis: A contribution to the clinical classification of phimosis

BACKGROUND

The literature regarding the quality of the sex life in adult males after circumcision, due to phimosis, is scarce and sometimes contrasting. This could be due to comparisons of a nonhomogeneous distribution of the clinical variables of men who have undergone circumcision.

OBJECTIVE

The objective of this study was to evaluate the distribution of the clinical variables in the adult male population who had circumcision for phimosis, and to propose a clinical classification of the phimosis to characterize it in adult males in more homogeneous sub-groups for the common clinical variables.

MATERIALS

A population of 244 adult male patients with phimosis was evaluated retrospectively. The mean age was 50.7 years. Each patient was classified according to the most common clinical variables. The variables that make up this classification of the phimosis were: Position (P1-2) to indicate if phimosis is present when the penis is at rest (P2) or only during an erection (P1); Grade (G 0-4) in relation to the extent of glans visibility; Complexity (Co 0-4) of comorbidities; Timespan (T 1-10) of the phimosis.

RESULTS

The distribution of the variables was the following: Position P1:30.73%, P2:69.26%; Grade G0:30.73%, G1:23.77%, G2:27.45%, G3:12.29%, G4:5.73%; Complexity (associated penile comorbidities): C0:48.36%, C1:4.5%, C2:0.8%, C3:43.03%, C4:3.27% Timespan: 57.78% of the patients had phimosis for less than a year; 18.03% between 1 and 2 years; 11.88% between 2 and 10 years; and 12.29% for more than 10 years.

CONCLUSIONS

The distribution of the clinical variables in the adult male population who underwent circumcision due to phimosis was not homogeneous regarding the appearance, severity, comorbidity, and timespan. This non-homogeneity could explain, in some cases, the contrasting results regarding the quality of sex life after circumcision in the literature. The proposed classification can offer an objective tool for researchers and clinicians group the patients into more homogeneous subgroups.