Abstract
Background: To develop and validate novel nomograms for better predicting the overall survival (OS) and cancer-specific survival (CSS) of patients with vulvar squamous cell cancer (VSCC).Methods: A retrospective analysis using a population-based database between 2004 and 2016 was carried. A 10-fold cross-validation with 200 repetitions was used to choose the best fit multivariate Cox model based on the net-benefit of decision curve analysis. Net-benefit, Harrell's C concordance statistic (C-statistic) of calibration plot, and area under the receiver operating characteristic curve (AUC) were used to evaluate the model prediction accuracy. Nomograms of the OS and CSS were generated based on the best fit model.Results: Of the 6,792 patients with VSCC, 5,094 (75%) and 1,698 (25%) were allocated to the training and validation cohort, respectively. All the variables were balanced between the training and validation cohorts. Age, insurance, tumor size, pathological grade, radiotherapy, chemotherapy, invasion depth, lymphadenectomy, sentinel lymph nodes biopsy, surgery, N stage, and M stage were in the best fit model for generating nomograms. The decision curve analysis, calibration plot, and receiver operating characteristic (ROC) curve show the better prediction performance of the model compared to previous studies. The C-statistics of our model for OS prediction are 0.80, 0.83, and 0.81 in the training, validation, and overall cohorts, respectively, while for CSS prediction are 0.83, 0.85, and 0.84. The AUCs for 3- and 5-year OS are the same and are 0.81, 0.83, and 0.81 in the training, validation, and overall cohorts, respectively. The AUCs for 3- and 5-year CSS are 0.78 and 0.80, 0.79 and 0.80, and 0.79 and 0.80 in those three cohorts.Conclusions: Our model shows the best prediction accuracy of the OS and CSS for patients with vulvar cancer (VC), which is of significant clinical practice value.
Highlights
Primary vulvar cancer (VC) is a rare malignancy that accounts for about 5% of all gynecologic cancer cases, with more than 6,100 newly diagnosed cases yearly and a rising death rate trends in the United States, leading to more than 1,400 in 2020 to 1,500 in 2021 [1, 2]
Insurance, tumor size, pathological grade, radiotherapy, chemotherapy, invasion depth, lymphadenectomy, sentinel lymph nodes biopsy, surgery, N stage, and M stage were in the best fit model for generating nomograms
Our model shows the best prediction accuracy of the overall survival (OS) and cancer-specific survival (CSS) for patients with vulvar cancer (VC), which is of significant clinical practice value
Summary
Primary vulvar cancer (VC) is a rare malignancy that accounts for about 5% of all gynecologic cancer cases, with more than 6,100 newly diagnosed cases yearly and a rising death rate trends in the United States, leading to more than 1,400 in 2020 to 1,500 in 2021 [1, 2]. The patients with regional lymph nodes involvement had worse survival [5]. SLNB is less aggressive and has a lower complication occurrence rate and could prolong the survival of patients with VSCC, so it is preferred as the replacement of lymphadenectomy for well-selected patients with VSCC. SLNB has a sensitivity of more than 95% to indicate lymph node involvement and a specialty of nearly 100% [8]. SLNB should be included as a predictor in nomograms for survival prediction. No nomograms for predicting the survival of the patients with VC have taken SLNB into account. To develop and validate novel nomograms for better predicting the overall survival (OS) and cancer-specific survival (CSS) of patients with vulvar squamous cell cancer (VSCC)
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