A prognostic nomogram for women with primary ovarian signet-ring cell carcinoma

Abstract

Background: Primary ovarian signet-ring cell carcinoma (POSRCC) is a rare subtype of ovarian carcinoma that is characterized by abundant mucin accumulation. POSRCC is aggressive, and the prognostic factors associated with its clinical outcome remain poorly defined. This study aimed to elucidate the clinical characteristics and survival of patients with POSRCC, and to establish an effective prognostic nomogram and risk stratification model to predict the risks associated with patient outcomes.Methods: Data of patients with POSRCC from the period 1975 to 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Univariable and multivariable analyses of demographic factors, clinicopathological characteristics, and treatments were conducted to identify significant prognostic parameters. The identified independent variables were integrated to develop a nomogram and risk stratification model. The discrimination and calibration of the nomogram were assessed with the concordance index (C-index), receiver operating characteristic (ROC) curves, and calibration curves.Results: A total of 172 patients were identified as being eligible to participate in this study. The median overall survival (OS) time was 7 months [95% confidence interval (CI), 4.6-9.4 months]. The 1-, 3-, and 5-year OS rates were 35.5%, 15.3%, and 6%, respectively. A multivariable analysis of the primary patients identified the independent predictors for survival as age at diagnosis, race, marital status, T (primary tumor size) stage, and chemotherapy, which were all incorporated into the nomogram. The C-index was 0.70 (95% CI, 0.66-0.75), which was statistically higher than that of the International Federation of Gynecology and Obstetrics (FIGO) staging system (0.58; 95% CI, 0.53-0.63). ROC curve analysis also showed that the nomogram had good discrimination, with an area under the curve (AUC) of 0.74, 0.62, and 0.71 for 1-, 3-, and 5-year survival, respectively. The calibration curves showed good agreement between the prediction by the nomogram and actual observations. A risk stratification model was further used to classify patients into a low-risk or high-risk group. The median OS time for the low-and high-risk groups was 13.0 months (95% CI, 9.33-16.67) and 2.0 months (95% CI, 1.12-2.89), respectively. Surgery did not significantly prolong survival in either group [low-risk group: hazard ratio (HR), 0.69; 95% CI, 0.45-1.07; P=0.09; high-risk group: HR, 0.55; 95% CI, 0.46-0.67; P=0.18]. Conclusions:The proposed nomogram and risk stratification model showed accurate prognostic prediction for POSRCC. These methods could improve individualized evaluations of survival and therapeutic decisions for patients with POSRCC.

Epidemiologic characteristics and a prognostic nomogram for patients with vulvar cancer: results from the Surveillance, Epidemiology, and End Results (SEER) program in the United States, 1975 to 2016

“…According to our findings, receiving surgical treatment and immunotherapy was beneficial to improve the OS of patients, both in the high- and low-risk groups. This is consistent with the findings of previous studies in vulvar cancer and other gynecologic tumors [ 14 22 36 ]. Two studies [ 14 22 ] included patients with vulvar SCC also showed that surgery treatment and immunotherapy were protective factors for all-cause mortality.…”

“…Two studies [ 14 22 ] included patients with vulvar SCC also showed that surgery treatment and immunotherapy were protective factors for all-cause mortality. Another study found that in ovarian cancer, immunotherapy was beneficial to prognosis in both high- and low-risk groups, but not in surgery [ 36 ].…”

A prognostic model of patients with ovarian mucinous adenocarcinoma: a population-based analysis

“…Currently, the use of nomograms is also increasing [7]. Wang et al [8] retrospectively analyzed 172 patients with primary ovarian signet cell carcinoma and constructed 1-year, 3-year, and 5-year OS nomograms, which were helpful for clinicians to assess the prognosis of patients. Wang et al [9] screened 131,050 patients with epithelial ovarian cancer from the seed database and constructed nomograms of OS and CSS.…”