AB013. SOH26AB_0156. Assessing the prognostic impact of neutrophil-to-lymphocyte ratio on survival in penile squamous cell carcinoma: a Cox-adjusted analysis controlling for stage and nodal burden

Background: The involvement of inguinal lymph nodes is associated with a poor prognosis in penile squamous cell carcinoma (PSCC). Neutrophil-to-lymphocyte ratio (NLR) has been suggested as an independent predictor of overall survival (OS) in patients with PSCC. We aimed to assess the prognostic value of pretreatment NLR in PSCC patients undergoing either lymph node biopsy (LNB) or dissection (LND).

Methods: A retrospective cohort study was performed for consecutive patients with PSCC who underwent LNB or LND between 2017 and 2025. Each patient had an indication for either dynamic LNB or modified or radical inguinal LND. NLR was subsequently calculated from neutrophil and lymphocyte counts on routine peripheral blood samples within 1 month prior to surgery. The association between NLR and specific clinicopathological characteristics was assessed using the Kruskal-Wallis test or Fisher’s exact test as appropriate. Kaplan-Meier analyses with log-rank testing were used to estimate OS stratified by NLR using a threshold previously reported in PSCC literature (<3 vs. ≥3). Cox proportional hazards models were used to determine predictors of survival. Follow-up was defined as the time from LND to the last follow-up or death.

Results: In total, 112 patients were included. Median age was 63.5 years [interquartile range (IQR), 55–72 years] and median NLR was 3.2 (IQR, 2.1–4.4). Median follow-up time was 20.5 months (IQR, 12.2–36.4 months). Overall, the 5-year survival rate was 62.8% [95% confidence interval (CI): 39.0–79.4%]. OS differed by tumour stage (T stage) [log-rank χ²(2)=9.41, P=0.009] and node stage (N stage)—progressively poorer outcomes were displayed with higher nodal involvement [log-rank χ²(3)=9.69, P=0.02]. On multivariate Cox regression, higher NLR was borderline but independently associated with worse OS after adjustment for N stage [hazard ratio (HR) =1.16; 95% CI: 1.00–1.33; P=0.04].

Conclusions: In patients with PSCC undergoing inguinal node surgery, pretreatment NLR independently predicts OS beyond nodal stage. NLR is a simple, inexpensive biomarker, which may be utilised in this high-risk population to aid individualised risk stratification and may help prioritise patients for early systemic therapy, intensified surveillance, or trial inclusion. V

Keywords: Cox-adjusted analysis; inguinal lymph node biopsy/dissection (inguinal LNB/LND); neutrophil-to-lymphocyte ratio (NLR); overall survival (OS); penile squamous cell carcinoma (PSCC)