Cancer medicine · 2026
Prognostic Nomograms and Scoring System: Novel Approaches to Forecast Overall Survival and Cancer-Specific Survival in Patients With Testicular Cancer.
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Huang Xiaoqi, Zhu Lian, Sun Mengjie, Zhou Yuan, Ding Yingman, Lin Changming
Аннотация
OBJECTIVES: To develop efficacious assessment tools to individualize the evaluation of overall survival (OS) and cancer-specific survival (CSS) in patients with testicular cancer.
METHODS: A total of 30,689 patients diagnosed with testicular cancer between 2004 and 2021 were selected from the Surveillance, Epidemiology, and End Results database. The study population was randomly divided into a training cohort and a validation cohort. Univariate and multivariate Cox analyses were conducted to identify significant predictors, which were subsequently utilized to construct nomograms for predicting 1-, 3-, 5-, and 10-year OS and CSS. The predictive performance of the nomograms underwent internal and external testing with the application of the concordance index (C-index), receiver operating characteristic curves, and calibration curves. We developed a prognostic scoring system based on the coefficients within the Cox models for each subgroup.
RESULTS: The significant predictors included age, race, marital status, TNM stage, radiation, chemotherapy, surgery and pathology. Age emerged as the most potent factor associated with overall and cancer-specific death (≥ 60 vs. < 30 years old: HR = 12.19 for OS and HR = 5.94 for CSS, p < 0.001). Among all pathological subtypes, choriocarcinoma exhibited the worst OS and CSS (reference seminoma: HR = 2.79 for OS and HR = 5.02 for CSS, p < 0.001). The favorable internal validation (C-index: 0.799 for OS and 0.859 for CSS; area under the curve = 0.773-0.892), external validation (C-index: 0.784 for OS and 0.867 for CSS) and calibration curves indicated the nomograms possessed good predictive ability. We developed a prognostic scoring system for the first time, which is more accurate than the traditional TNM system in evaluating patients' survival outcomes.
CONCLUSION: The prognostic nomograms and scoring systems are capable of effectively evaluating the 1-, 3-, 5-, and 10-year OS and CSS of testicular cancer patients and providing a reliable tool for optimizing clinical treatment decisions and follow-up management.
METHODS: A total of 30,689 patients diagnosed with testicular cancer between 2004 and 2021 were selected from the Surveillance, Epidemiology, and End Results database. The study population was randomly divided into a training cohort and a validation cohort. Univariate and multivariate Cox analyses were conducted to identify significant predictors, which were subsequently utilized to construct nomograms for predicting 1-, 3-, 5-, and 10-year OS and CSS. The predictive performance of the nomograms underwent internal and external testing with the application of the concordance index (C-index), receiver operating characteristic curves, and calibration curves. We developed a prognostic scoring system based on the coefficients within the Cox models for each subgroup.
RESULTS: The significant predictors included age, race, marital status, TNM stage, radiation, chemotherapy, surgery and pathology. Age emerged as the most potent factor associated with overall and cancer-specific death (≥ 60 vs. < 30 years old: HR = 12.19 for OS and HR = 5.94 for CSS, p < 0.001). Among all pathological subtypes, choriocarcinoma exhibited the worst OS and CSS (reference seminoma: HR = 2.79 for OS and HR = 5.02 for CSS, p < 0.001). The favorable internal validation (C-index: 0.799 for OS and 0.859 for CSS; area under the curve = 0.773-0.892), external validation (C-index: 0.784 for OS and 0.867 for CSS) and calibration curves indicated the nomograms possessed good predictive ability. We developed a prognostic scoring system for the first time, which is more accurate than the traditional TNM system in evaluating patients' survival outcomes.
CONCLUSION: The prognostic nomograms and scoring systems are capable of effectively evaluating the 1-, 3-, 5-, and 10-year OS and CSS of testicular cancer patients and providing a reliable tool for optimizing clinical treatment decisions and follow-up management.