Advertisement

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
  • 68 Downloads

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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

Keywords

Primary urethral carcinoma Overall survival Cancer-specific survival Nomogram SEER 

Abbreviations

PUC

Primary urethral carcinoma

AJCC

American Joint Committee on Cancer

SEER

Surveillance, Epidemiology, and End Results

OS

Overall survival

CSS

Cancer-specific survival

ICD-O-3

The third revision of International Classification of Disease for Oncology

TCC

Transitional cell carcinoma

SCC

Squamous cell carcinoma

AC

Adenocarcinoma

HR

Hazard ratio

CI

Confidence interval

C-index

Consistency index

AUC

Area under the receiver operating characteristics curve

DCA

Decision-curve analysis

Notes

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.

Funding

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.

Supplementary material

11255_2019_2314_MOESM1_ESM.tiff (1.5 mb)
Supplementary material 1 (TIFF 1582 kb)
11255_2019_2314_MOESM2_ESM.tiff (1.5 mb)
Supplementary material 2 (TIFF 1582 kb)
11255_2019_2314_MOESM3_ESM.tiff (1.5 mb)
Supplementary material 3 (TIFF 1582 kb)
11255_2019_2314_MOESM4_ESM.tiff (1.5 mb)
Supplementary material 4 (TIFF 1582 kb)
11255_2019_2314_MOESM5_ESM.tiff (1.5 mb)
Supplementary material 5 (TIFF 1582 kb)
11255_2019_2314_MOESM6_ESM.tiff (1.5 mb)
Supplementary material 6 (TIFF 1582 kb)
11255_2019_2314_MOESM7_ESM.tiff (1.5 mb)
Supplementary material 7 (TIFF 1582 kb)
11255_2019_2314_MOESM8_ESM.tiff (1.5 mb)
Supplementary material 8 (TIFF 1582 kb)
11255_2019_2314_MOESM9_ESM.tiff (1.5 mb)
Supplementary material 9 (TIFF 1582 kb)
11255_2019_2314_MOESM10_ESM.tiff (1.5 mb)
Supplementary material 10 (TIFF 1582 kb)
11255_2019_2314_MOESM11_ESM.tiff (1.5 mb)
Supplementary material 11 (TIFF 1582 kb)
11255_2019_2314_MOESM12_ESM.tiff (1.5 mb)
Supplementary material 12 (TIFF 1582 kb)

References

  1. 1.
    Ampil FL (1985) Primary malignant neoplasm of the female urethra. Obstet Gynecol 66(6):799–804PubMedGoogle Scholar
  2. 2.
    Melicow MM, Roberts TW (1978) Pathology and natural history of urethral tumors in males. Review of 142 cases. Urology 11(1):83–89.  https://doi.org/10.1016/0090-4295(78)90212-1 CrossRefPubMedGoogle Scholar
  3. 3.
    Amin MB, Young RH (1997) Primary carcinomas of the urethra. Semin Diagn Pathol 14(2):147–160PubMedGoogle Scholar
  4. 4.
    Sui W, RoyChoudhury A, Wenske S, Decastro GJ, McKiernan JM, Anderson CB (2017) Outcomes and Prognostic Factors of Primary Urethral Cancer. Urology 100:180–186.  https://doi.org/10.1016/j.urology.2016.09.042 CrossRefPubMedGoogle Scholar
  5. 5.
    Champ CE, Hegarty SE, Shen X, Mishra MV, Dicker AP, Trabulsi EJ, Lallas CD, Gomella LG, Hyslop T, Showalter TN (2012) Prognostic factors and outcomes after definitive treatment of female urethral cancer: a population-based analysis. Urology 80(2):374–381.  https://doi.org/10.1016/j.urology.2012.02.058 CrossRefPubMedGoogle Scholar
  6. 6.
    Abudurexiti M, Wang J, Shao N, Wan FN, Zhu Y, Dai B, Ye DW (2018) Prognosis of rare pathological primary urethral carcinoma. Cancer Manag Res 10:6815–6822.  https://doi.org/10.2147/cmar.s184197 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Wei Y, Wu YP, Xu N, Li XD, Chen SH, Cai H, Zheng QS, Xue XY (2017) Sex-related differences in clinicopathological features and survival of patients with primary urethral carcinoma: a population-based study. Onco Targets Ther 10:3381–3389.  https://doi.org/10.2147/ott.s139252 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Gakis G, Morgan TM, Efstathiou JA, Keegan KA, Mischinger J, Todenhoefer T, Schubert T, Zaid HB, Hrbacek J, Ali-El-Dein B, Clayman RH, Galland S, Olugbade K Jr, Rink M, Fritsche HM, Burger M, Chang SS, Babjuk M, Thalmann GN, Stenzl A, Daneshmand S (2016) Prognostic factors and outcomes in primary urethral cancer: results from the international collaboration on primary urethral carcinoma. World J Urol 34(1):97–103.  https://doi.org/10.1007/s00345-015-1583-7 CrossRefPubMedGoogle Scholar
  9. 9.
    Wang W, Hong J, Meng J, Wu H, Shi M, Yan S, Huang Y (2019) Nomograms predict cancer-specific and overall survival of patients with primary limb leiomyosarcoma. J Orthop Res 37(7):1649–1657.  https://doi.org/10.1002/jor.24298 CrossRefPubMedGoogle Scholar
  10. 10.
    Yan P, Huang R, Hu P, Liu F, Zhu X, Hu P, Yin H, Zhang J, Meng T, Huang Z (2019) Nomograms for predicting the overall and cause-specific survival in patients with malignant peripheral nerve sheath tumor: a population-based study. J Neurooncol 143(3):495–503.  https://doi.org/10.1007/s11060-019-03181-4 CrossRefPubMedGoogle Scholar
  11. 11.
    Jiang WD, Yuan PC (2019) Development and validation of prognostic nomograms for patients with metastatic prostate cancer. Int Urol Nephrol.  https://doi.org/10.1007/s11255-019-02224-z CrossRefPubMedGoogle Scholar
  12. 12.
    Kawachi MH, Bahnson RR, Barry M, Busby JE, Carroll PR, Carter HB, Catalona WJ, Cookson MS, Epstein JI, Etzioni RB, Giri VN, Hemstreet GP 3rd, Howe RJ, Lange PH, Lilja H, Loughlin KR, Mohler J, Moul J, Nadler RB, Patterson SG, Presti JC, Stroup AM, Wake R, Wei JT (2010) NCCN clinical practice guidelines in oncology: prostate cancer early detection. J Natl Compr Canc Netw 8(2):240–262CrossRefGoogle Scholar
  13. 13.
    Caulfield S, Menezes G, Marignol L, Poole C (2018) Nomograms are key decision-making tools in prostate cancer radiation therapy. Urol Oncol 36(6):283–292.  https://doi.org/10.1016/j.urolonc.2018.03.017 CrossRefPubMedGoogle Scholar
  14. 14.
    Hyder O, Marques H, Pulitano C, Marsh JW, Alexandrescu S, Bauer TW, Gamblin TC, Sotiropoulos GC, Paul A, Barroso E, Clary BM, Aldrighetti L, Ferrone CR, Zhu AX, Popescu I, Gigot JF, Mentha G, Feng S, Pawlik TM (2014) A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma: an Eastern and Western experience. JAMA Surg 149(5):432–438.  https://doi.org/10.1001/jamasurg.2013.5168 CrossRefPubMedGoogle Scholar
  15. 15.
    Xie HY, Zhu Y, Yao XD, Zhang SL, Dai B, Zhang HL, Shen YJ, Wang CF, Zhang HZ, Ye DW (2012) Development of a nomogram to predict non-organ-confined bladder urothelial cancer before radical cystectomy. Int Urol Nephrol 44(6):1711–1719.  https://doi.org/10.1007/s11255-012-0273-2 CrossRefPubMedGoogle Scholar
  16. 16.
    Kara O, Elshafei A, Nyame YA, Akdogan B, Malkoc E, Gao T, Altan M, Citamak B, Mammadov E, Dursun F, Greene DJ, Senkul T, Ates F, Ozen H, Stephen Jones J (2016) The nomogram conundrum: a demonstration of why a prostate cancer risk model in Turkish men underestimates prostate cancer risk in the USA. Int Urol Nephrol 48(10):1623–1629.  https://doi.org/10.1007/s11255-016-1328-6 CrossRefPubMedGoogle Scholar
  17. 17.
    Royston P, Altman DG (2013) External validation of a Cox prognostic model: principles and methods. BMC Med Res Methodol 13:33.  https://doi.org/10.1186/1471-2288-13-33 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Vickers AJ, Elkin EB (2006) Decision curve analysis: a novel method for evaluating prediction models. Med Decis Making 26(6):565–574.  https://doi.org/10.1177/0272989x06295361 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Gakis G, Witjes JA, Bruins M, Compérat E, Cowan NC, Hernàndez V, Lebret T, Lorch A, Ribal MJ, van der Heijden AG, Veskimäe E (2018) EAU Guidelines on Primary Urethral Carcinoma 2018. In: European Association of Urology Guidelines. 2018 Edition., vol presented at the EAU Annual Congress Copenhagen 2018. European Association of Urology Guidelines Office, Arnhem, The Netherlands.Google Scholar
  20. 20.
    Visser O, Adolfsson J, Rossi S, Verne J, Gatta G, Maffezzini M, Franks KN (2012) Incidence and survival of rare urogenital cancers in Europe. Eur J Cancer 48(4):456–464.  https://doi.org/10.1016/j.ejca.2011.10.031 CrossRefPubMedGoogle Scholar
  21. 21.
    Derksen JW, Visser O, de la Riviere GB, Meuleman EJ, Heldeweg EA, Lagerveld BW (2013) Primary urethral carcinoma in females: an epidemiologic study on demographical factors, histological types, tumour stage and survival. World J Urol 31(1):147–153.  https://doi.org/10.1007/s00345-012-0882-5 CrossRefPubMedGoogle Scholar
  22. 22.
    Karnes RJ, Breau RH, Lightner DJ (2010) Surgery for urethral cancer. Urol Clin North Am 37(3):445–457.  https://doi.org/10.1016/j.ucl.2010.04.011 CrossRefPubMedGoogle Scholar
  23. 23.
    Son CH, Liauw SL, Hasan Y, Solanki AA (2018) Optimizing the role of surgery and radiation therapy in urethral cancer based on histology and disease extent. Int J Radiat Oncol Biol Phys 102(2):304–313.  https://doi.org/10.1016/j.ijrobp.2018.06.007 CrossRefPubMedGoogle Scholar
  24. 24.
    Lucarelli G, Spilotros M, Vavallo A, Palazzo S, Miacola C, Forte S, Matera M, Campagna M, Colamonico O, Schiralli F, Sebastiani F, Di Cosmo F, Bettocchi C, Di Lorenzo G, Buonerba C, Vincenti L, Ludovico G, Ditonno P, Battaglia M (2016) A challenging surgical approach to locally advanced primary urethral carcinoma: a case report and literature review. Med (Baltim) 95(19):e3642.  https://doi.org/10.1097/md.0000000000003642 CrossRefGoogle Scholar
  25. 25.
    Kent M, Zinman L, Girshovich L, Sands J, Vanni A (2015) Combined chemoradiation as primary treatment for invasive male urethral cancer. J Urol 193(2):532–537.  https://doi.org/10.1016/j.juro.2014.07.105 CrossRefPubMedGoogle Scholar
  26. 26.
    Gakis G, Morgan TM, Daneshmand S, Keegan KA, Todenhofer T, Mischinger J, Schubert T, Zaid HB, Hrbacek J, Ali-El-Dein B, Clayman RH, Galland S, Olugbade K, Rink M, Fritsche HM, Burger M, Chang SS, Babjuk M, Thalmann GN, Stenzl A, Efstathiou JA (2015) Impact of perioperative chemotherapy on survival in patients with advanced primary urethral cancer: results of the international collaboration on primary urethral carcinoma. Ann Oncol 26(8):1754–1759.  https://doi.org/10.1093/annonc/mdv230 CrossRefPubMedGoogle Scholar
  27. 27.
    Dayyani F, Pettaway CA, Kamat AM, Munsell MF, Sircar K, Pagliaro LC (2013) Retrospective analysis of survival outcomes and the role of cisplatin-based chemotherapy in patients with urethral carcinomas referred to medical oncologists. Urol Oncol 31(7):1171–1177.  https://doi.org/10.1016/j.urolonc.2012.01.011 CrossRefPubMedGoogle Scholar
  28. 28.
    Wang F, Zhang H, Wen J, Zhou J, Liu Y, Cheng B, Chen X, Wei J (2018) Nomograms forecasting long-term overall and cancer-specific survival of patients with oral squamous cell carcinoma. Cancer Med 7(4):943–952.  https://doi.org/10.1002/cam4.1216 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Fitzgerald M, Saville BR, Lewis RJ (2015) Decision curve analysis. Jama 313(4):409–410.  https://doi.org/10.1001/jama.2015.37 CrossRefPubMedGoogle Scholar
  30. 30.
    Zheng J, Kong J, Wu S, Li Y, Cai J, Yu H, Xie W, Qin H, Wu Z, Huang J, Lin T (2019) Development of a noninvasive tool to preoperatively evaluate the muscular invasiveness of bladder cancer using a radiomics approach. Cancer.  https://doi.org/10.1002/cncr.32490 CrossRefPubMedGoogle Scholar
  31. 31.
    Wang K, Gong M, Xie S, Zhang M, Zheng H, Zhao X, Liu C (2019) Nomogram prediction for the 3-year risk of type 2 diabetes in healthy mainland China residents. Epma j 10(3):227–237.  https://doi.org/10.1007/s13167-019-00181-2 CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Ma K, Dong B, Wang L, Zhao C, Fu Z, Che C, Liu W, Yang Z, Liang R (2019) Nomograms for predicting overall survival and cancer-specific survival in patients with surgically resected intrahepatic cholangiocarcinoma. Cancer Manag Res 11:6907–6929.  https://doi.org/10.2147/cmar.s212149 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Rousson V, Zumbrunn T (2011) Decision curve analysis revisited: overall net benefit, relationships to ROC curve analysis, and application to case-control studies. BMC Med Inform Decis Mak 11:45.  https://doi.org/10.1186/1472-6947-11-45 CrossRefPubMedPubMedCentralGoogle Scholar

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

Personalised recommendations