Abstract
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.
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