Survival study of patients with stage N1-3 testicular seminoma / 国际肿瘤学杂志

ABSTRACT

Objective To explore the independent predictors for disease-specific survival (DSS) rate in patients with stage N1-3 testicular seminoma (TS),and establish a nomogram to predict individual 5-year DSS.Methods The data of N1-3 TS patients registered in the SEER database of National Cancer Institute (USA) from January 2004 to December 2015 were retrospectively analyzed.The 5-year overall survival (OS) rate and DSS rate were calculated using Kaplan-Meier method and the differences among different subgroups were assessed using log-rank test.Besides,the independent predictors of DSS were defined using multivariate Cox regression analysis,and nomogram was drawn using R software.Furthermore,the predictive performance of the nomogram was internally validated using the C-index and calibration plot.Results TNM stage ⅢA (HR =5.604,95％ CI1.252-25.083,P =0.024),ⅢB (HR =6.710,95％ CI1.923-23.410,P =0.003) and ⅢC (HR =13.189,95％ CI3.916-44.420,P ＜ 0.001),age at diagnosis ≥45 years old (HR =3.575,95％ CI2.014-6.344,P ＜ 0.001),and patients without spouse (HR =2.346,95％ CI1.406-3.914,P =0.001) were identified as independent risk factors for DSS.On internal validation,the predictive accuracy of our nomogram was 0.751 (C-index0.751,95％ CI0.694-0.808).Besides,the calibration plot showed that the predicted survival outcomes were highly consistent with the actual survival outcomes.Conclusion The study confirms that age at diagnosis ≥45 years old,TNM stage ≥ ⅢA and patients without spouse are the independent risk factors for DSS in TS patients with stage N1-3,and the nomogram for predicting individual 5-year DSS is established.