Nomograms for predicting long-term overall survival and cancer-specific survival in patients with primary urethral carcinoma: a population-based study

  • Hao Zi
  • Lei Gao
  • Zhaohua Yu
  • Chaoyang Wang
  • Xuequn Ren
  • Jun Lyu
  • Xiaodong LiEmail author
Urology - Original Paper



Our aim was to identify the independent prognostic factors in patients with primary urethral carcinoma (PUC) and to predict their overall survival (OS) and cancer-specific survival (CSS) at 3, 5, and 8 years.


Patients with PUC identified in the Surveillance, Epidemiology, and End Results (SEER) database were divided into training and validation cohorts. Nomograms were constructed based on the results of Cox regression analysis. The predictive performance of each nomogram was evaluated using the consistency index (C-index), the area under the receiver operating characteristics curve (AUC), and calibration plots. Decision-curve analysis (DCA) was used to test the clinical value of the predictive models.


Our study screened 822 patients with PUC. Multivariate analysis showed that the age at diagnosis, race, histology, American Joint Committee on Cancer (AJCC) stage, and surgery status were independent prognostic factors for CSS and age at diagnosis, race, histology, AJCC stage, surgery status, and chemotherapy for OS (all P < 0.05). We used these prognostic factors to construct nomograms. The C-indexes for OS and CSS were 0.713 and 0.741 in training cohorts and 0.714 and 0.738 in validation cohorts, respectively. The AUC and calibration plots demonstrated the good performance of both nomograms. The DCA indicated the presence of clinical net benefits in both the training and validation cohorts.


We developed and validated nomograms for predicting OS and CSS in patients with PUC, which can help clinicians make treatment decisions.


Primary urethral carcinoma Overall survival Cancer-specific survival Nomogram SEER 



Primary urethral carcinoma


American Joint Committee on Cancer


Surveillance, Epidemiology, and End Results


Overall survival


Cancer-specific survival


The third revision of International Classification of Disease for Oncology


Transitional cell carcinoma


Squamous cell carcinoma




Hazard ratio


Confidence interval


Consistency index


Area under the receiver operating characteristics curve


Decision-curve analysis


Author contributions

HZ and XDL were responsible for conception, design, and quality control of this study. LG, ZHY, and CYW conducted data management, analysis, and interpretation. HZ and JL participated in statistical analyses. HZ, LG, ZHY, and CYW contributed to manuscript drafting and editing. XQR and XDL reviewed the manuscript.


Not applicable.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval

Not applicable.

Informed consent

Since all of the information in the SEER database has been de-identified, no institutional review board approval or informed consent was required for this study.

Consent for publication

All authors listed approved the publication of the manuscript.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Institute of Evidence-Based Medicine and Knowledge TranslationHenan UniversityKaifengChina
  2. 2.Department of UrologyHuaihe Hospital of Henan UniversityKaifengChina
  3. 3.Department of General SurgeryHuaihe Hospital of Henan UniversityKaifengChina
  4. 4.Clinical Research CenterThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina

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