Prognostic nomograms to predict overall survival and cause specific death in vulvar squamous cell carcinoma

Abstract

ObjectiveThe incidence of vulvar squamous cell carcinoma has been rising in recent decades. The prognosis of patients with vulvar squamous cell carcinoma was explored, and nomograms were constructed to predict survival rates.MethodsVulvar squamous cell carcinoma patient data were downloaded from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into a training dataset and testing dataset. Univariable and multivariable Cox regression were used to identify risk factors affecting vulvar squamous cell carcinoma overall survival in the training dataset. Cumulative incidence function and Fine–Gray regression were used to analyze cancer specific death in the training dataset. Overall survival and cancer specific death nomograms were constructed and validated in the testing and whole datasets. Receiver operating characteristic and calibration were used to verify the predictive value and clinical applicability of the models.ResultsAge ≥60 years, grade 3, American Joint Committee on Cancer stages III and IV, TNM (tumor, nodes, metastasis) stages T2, T3, N1, and M1 had a negative effect on overall survival in vulvar cancer patients. Surgery (hazard ratio (HR)=0.416, 95% confidence interval (CI) 0.349 to 0.496, p<0.001) and chemotherapy (HR=0.637, 95% CI 0.544 to 0.746, p<0.001) may improve overall survival. Age, tumor grade, American Joint Committee on Cancer stage, T stage, N stage, M stage, surgery, and chemotherapy significantly affected vulvar cancer specific death. For area under the receiver operating characteristic curve, the predictive ability of the nomograms for overall survival and cancer specific death for 1 year (area under the curve (AUC)=0.862), 3 years (AUC=0.832), and 5 years (AUC=0.808) were all >0.800.ConclusionThe nomograms established in our study had an excellent predictive ability for overall survival and cancer specific death in vulvar cancer patients.

Establishment and validation of a nomogram for estimating the overall survival of vulvar squamous cell carcinoma patients aged 50 years or older

“…However, a previous study reported that the relationship between age and overall patient survival was uncertain [22]. We also observed that chemotherapy was associated with improved OS, which was concordant with Mao Y et al [14] and Vulcan et al [23]. However, Scampa et al [16] contrastingly observed that chemotherapy was not associated with OS benefits, possibly because it was mostly prescribed in patients with advanced diseases, thereby demonstrating lower survival rates.…”

“…DCA: decision curve analysis. due to inconsistency with previous studies [14]. We consider that this observation could be related to the inevitable selection bias of the SEER database.…”

“…Nomogram is a widely used graphical scoring model that combines various independent risk factors to predict the overall survival of cancer patients [10,11]. Presently, there are limited studies on nomograms for vulvar cancer [12][13][14][15][16] and none for elderly vulvar cancer patients. Considering that these patients are at high risk of developing complications and mortality, it is very important to identify prognostic factors that could affect their prognosis, accurately estimate their overall survival and develop individualized treatments that could improve their outcomes.…”

An integrated model for prognosis in vulvar squamous cell carcinoma

“…In this study, we found that LNM was a negative predictor for PFS but not for OS in multivariate models. Many previous studies supported that LNM was strongly correlated with both OS and PFS [ 31 , 33 , 35 ]. Of note, a multicenter retrospective study showed that adjuvant therapy (radiotherapy or chemoradiotherapy) significantly improved the 3-year PFS in VSSC patients with LNM compared with those who did not receive postoperative adjuvant therapy [ 36 ].…”

“…It is worth noting that the staging system (SEER staging system) was used in the Jin L et al study not based on FIGO or AJCC staging system and only divided tumors into three substages (stage I - localized, stage II - regional, or stage III - distant) [ 34 ]. Mao Y et al observed that advanced AJCC and TNM (tumor, nodes, metastasis) stage but not SEER stage was correlated with adverse survival outcomes in their screened SEER cohorts (4681 VSCC patients) [ 35 ]. Another important prognostic clinical factor was LNM, the status of which was closely related to tumor staging, risk of recurrence, and decision on postoperative adjuvant therapy.…”