Clinical features and prognostic factors in patients diagnosed with lymphovascular invasion of testicular germ-cell tumors: Analysis based on the SEER database

Hu Ke; Shengming Jiang; Ziqi He; Qianlin Song; Dashuai Yang; Chao Song; Caitao Dong; Junwei Liu; Xiaozhe Su; Jiawei Zhou; Yunhe Xiong

doi:10.3389/fonc.2023.1142441

Clinical features and prognostic factors in patients diagnosed with lymphovascular invasion of testicular germ-cell tumors: Analysis based on the SEER database

Front Oncol. 2023 Mar 3:13:1142441. doi: 10.3389/fonc.2023.1142441. eCollection 2023.

Authors

Hu Ke¹, Shengming Jiang¹, Ziqi He¹, Qianlin Song¹, Dashuai Yang², Chao Song¹, Caitao Dong¹, Junwei Liu¹, Xiaozhe Su¹, Jiawei Zhou¹, Yunhe Xiong¹

Affiliations

¹ Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
² Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, China.

Abstract

Background: Lymphovascular invasion (LVI) is a high-risk factor for testicular germ-cell tumors (TGCT), but a prognostic model for TGCT-LVI patients is lacking. This study aimed to develop a nomogram for predicting the overall survival (OS) of TGCT-LVI patients.

Methods: A complete cohort of 3288 eligible TGCG-LVI patients (training cohort, 2300 cases; validation cohort, 988 cases) were obtained from the Surveillance, Epidemiology, and End Results database. Variables screened by multivariate Cox regression analysis were used to construct a nomogram, which was subsequently evaluated using the consistency index (C-index), time-dependent receiver operating characteristic curve (ROC), and calibration plots. The advantages and disadvantages of the American Joint Committee on Cancer (AJCC) staging system and the nomogram were assessed by integrated discrimination improvement (IDI) and net reclassification improvement (NRI). Decision-analysis curve (DCA) was used to measure the net clinical benefit of the nomogram versus the AJCC staging system. Finally, Kaplan-Meier curves were used to evaluate the ability to identify different risk groups between the traditional AJCC staging system and the new risk-stratification system built on the nomogram.

Results: Nine variables were screened by multivariate Cox regression analysis to construct the nomogram. The C-index (training cohort, 0.821; validation cohort, 0.819) and time-dependent ROC of 3-, 5-, and 9-year OS between the two cohorts suggested that the nomogram had good discriminatory ability. Calibration curves showed good consistency of the nomogram. The NRI values of 3-, 5-, and 9-year OS were 0.308, 0.274, and 0.295, respectively, and the corresponding values for the validation cohort were 0.093, 0.093, and 0.099, respectively (P<0.01). Additionally, the nomogram had more net clinical benefit as shown by the DCA curves, and the new risk-stratification system provided better differentiation than the AJCC staging system.

Conclusions: A prognostic nomogram and new risk-stratification system were developed and validated to assist clinicians in assessing TGCT-LVI patients.

Keywords: SEER; lympho-vascular invasion; nomogram; overall survival; prognosis; testicular germ cell tumor.