Frontiers in Medical Science Research, 2021, 3(2); doi: 10.25236/FMSR.2021.030209.
Min Liu1, Li Li2, Juan Du3, Jun Lyu2, Zuhui Chen4
1Department of Hospital Infection Control, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
2Department of Clinical Research, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
3Department of Hygiene Inspection & Quarantine Science, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
4Office of Science, Education and Student management, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
Background: Vulvar carcinoma (VC) is a rare female gynecological malignancy, and optimizing prognostic factors for VC requires large-scale research containing various clinical indicators of patients. Our study attempted to develop and validate a detailed survival nomogram for predicting the overall survival (OS) probability in patients diagnosed with VC. Methods: Patients diagnosed with VC between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were performed followed by the construction of the nomogram for OS. The performance of this model was evaluated using the concordance index (C-index), area under the time-dependent receiver operating characteristics curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration plots and decision curve analysis (DCA). In addition, the C-index, AUC and DCA of the model and the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system were compared. Results: A total of 6275 patients were randomly assigned to the training cohort (n=4392) and the validation cohort (n=1883). Multivariate analysis identified independent prognostic factors (p<0.05) for OS, including histological type, age, surgery, T stage, N stage, M stage, grade, summary stage, chemotherapy, race, marital status and size. Finally, a nomogram was constructed to predict the 3-, 5-, and 8-year OS probabilities for patients with VC, and the C-index, NRI, IDI and calibration plotting all showed that the model has good discrimination. Additionally, the nomogram also showed better clinical validity of the DCA and AUC compared to that of the FIGO system. Conclusions: We developed and validated a nomogram for individual OS prediction in patients with VC. While further validation is required, this nomogram may be a useful comprehensive prognostic tool to give patients a better idea of prognosis during counseling.
Vulvar carcinoma, Nomogram, FIGO, Overall survival, SEER, Prognostic
Min Liu, Li Li, Juan Du, Jun Lyu, Zuhui Chen. Establishment and validation of a nomogram for predicting overall survival in patients with vulvar carcinoma based on the SEER database. Frontiers in Medical Science Research (2021) Vol. 3 Issue 2: 37-47. https://doi.org/10.25236/FMSR.2021.030209.
[1] Judson PL, Habermann EB, Baxter NN, et al. Trends in the incidence of invasive and in situ vulvar carcinoma. Obstet Gynecol, 2006, 107:1018-1022.
[2] Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 2021, 0:1-41.
[3] Michalski BM, Pfeifer JD, Mutch D, et al. Cancer of the Vulva: A Review. Dermatol Surg 2021, 47(2):174-183.
[4] Kang YJ, Smith M, Barlow E, et al. Vulvar cancer in high-income countries: Increasing burden of disease. Int J Cancer, 2017,141(11):2174-2186.
[5] Oonk MHM, Planchamp F, Baldwin P, et, al. European Society of Gynaecological Oncology Guidelines for the Management of Patients With Vulvar Cancer. Int J Gynecol Cancer, 2017, 27(4):832-837.
[6] Hacker NF. Revised FIGO staging for carcinoma of the vulva. Int J Gynaecol Obstet, 2009, 105(2):105-6.
[7] Wu SG, Zhang WW, Li FY, et al. Lymph node ratio has prognostic value related to the number of positive lymph nodes in patients with vulvar cancer. Future Oncol, 2018, 14(23):2343-2351.
[8] Rauh-Hain JA, Clemmer J, Clark RM, et al. Racial disparities and changes in clinical characteristics and survival for vulvar cancer over time. Am J Obstet Gynecol, 2013, 209(5):468?
[9] Lei L, Tan L, Zhao X, et al. A prognostic nomogram based on lymph node ratio for postoperative vulvar squamous cell carcinoma from the Surveillance, Epidemiology, and End Results database: a retrospective cohort study. Ann Transl Med, 2020,8(21):1382.
[10] Iasonos A, Schrag D, Raj GV, et al. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol, 2008, 26(8):1364-70.
[11] Duggan MA, Anderson WF, Altekruse S, et al. The Surveillance, Epidemiology, and End Results (SEER) Program and Pathology: Toward Strengthening the Critical Relationship. Am J Surg Pathol, 2016,40(12): 94-102.
[12] Zhou H, Zou X, Li H, et al. Construction and validation of a prognostic nomogram for primary vulvar melanoma: a SEER population-based study. Jpn J Clin Oncol, 2020,50(12):1386-1394.
[13] Li C, Yang J, Zheng S, et al. Establishment and Validation of a Nomogram for Tonsil Squamous Cell Carcinoma: A Retrospective Study Based on the SEER Database. Cancer Control. 2020,27(1).
[14] Parikh CR, Devarajan P, Zappitelli M, et, al. Postoperative biomarkers predict acute kidney injury and poor outcomes after pediatric cardiac surgery. J Am Soc Nephrol, 2011,22(9):1737-47.
[15] Steyerberg EW, Vickers AJ, Cook NR, et al. Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology, 2010,21(1):128-38.
[16] Chen PP, Ramalingam P, Alvarado-Cabrero I, et al. High-grade Neuroendocrine Carcinomas of the Vulva: A Clinicopathologic Study of 16 Cases. Am J Surg Pathol, 2021,45(3):304-316.
[17] Johnson LR, Nair RP, Sambasivan S. Adenoid cystic carcinoma of vulva-11 Years’ single-institution experience. J Obstet Gynecol Ind, 2017,67:196-201.
[18] Opfermann KJ, Wahlquist, AE, Garrett-Mayer E. SEER Data: surveillance, Epidemiology and End Results. Am J Clin Oncol-Canc, 2014,37:112-116.
[19] Froeding LP, Hogdall C, Kristensen, E. Recurrence and survival rates in node negative patients after sentinel node biopsy for early-stage vulva cancer-A nationwide study. Gynecol Oncol, 2020, 156:124-130.
[20] Nishio S, Murotani K, Nakao S. Investigation of clinicopathological features of vulvar cancer in 1068 patients: A Japanese Gynecologic Oncology Group (JGOG) nationwide survey study. Gynecol Oncol, 2020, 159:449-455.
[21] Tergas AI, Tseng JH, Bristow RE. Impact of race and ethnicity on treatment and survival of women with vulvar cancer in the United States. Gynecol Oncol,2013,129(1):154-8.
[22] Bray F, Laversanne M, Weiderpass E, et al. Geographic and temporal variations in the incidence of vulvar and vaginal cancers. Int J Cancer,2020,147(10):2764-2771.
[23] Velden J, Fons G, Lawrie TA. Primary groin irradiation versus primary groin surgery for early vulvar cancer. Cochrane Database Syst Rev 5.2011.
[24] Wang Y, Li J, Xia Y, et al. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy. J Clin Oncol,2013, 31(9):1188-95.
[25] Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology, 1983,148(3):839-843.
[26] Iki M, Fujita Y, Tamaki J, et al. Trabecular bone score may improve FRAX® prediction accuracy for major osteoporotic fractures in elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study. Osteoporos Int, 2015,26(6):1841-8.
[27] Chambless LE, Cummiskey CP, Cui G. Several methods to assess improvement in risk prediction models: extension to survival analysis. Stat Med, 2011,30:22-38.