Abstract：
OBJECTIVE: The aim of this study was to introduce HPV-associated and HPV-independent histologic classifications to analyze prognostic factors and develop a prognostic nomogram for patients with penile squamous cell carcinoma (PSCC).
METHODS: Data of 1502 PSCC patients between 2010 and 2020 were accessed from the SEER database, and the patients were randomly divided into a training set and a validation set. Independent risk factors for PSCC patients prognosis were analyzed by using univariate and multivariate COX proportional hazards regression, and was used for the construction of the nomogram, and the predictive performance of the model was evaluated by C-index, calibration curve and ROC curve. Kaplan-Meier analysis was applied to explore the impact of HPV-related factors on patient survival, while propensity score matching (PSM) and inverse probability treatment weighting (IPTW) techniques were used to balance other confounding factors like individual clinical and pathological factors, and to evaluate the differences in overall survival (OS) and cause-specific survival (CSS) between subgroups.
RESULTS: The results indicated that histologic type, Grade classification, T/M stage, surgical methods and chemotherapy were independent risk factors affecting OS and CSS in PSCC patients. In addition, age and marital status were significantly associated with OS, while lymph node metastasis was an independent prognostic factor for CSS, the validation results of the model showed that the nomogram had a superior predictive performance compared with the American Joint Committee on Cancer staging system. In addition, subgroup analyses prior to and after IPTW and PSM adjustments showed that HPV-associated group had better OS and CSS than HPV-independent group.
CONCLUSIONS: Our study developed and validated a nomogram using a novel histologic classification and achieved satisfactory results, which can better help clinicians to predict the prognosis of penile squamous cell carcinoma patients.
METHODS: Data of 1502 PSCC patients between 2010 and 2020 were accessed from the SEER database, and the patients were randomly divided into a training set and a validation set. Independent risk factors for PSCC patients prognosis were analyzed by using univariate and multivariate COX proportional hazards regression, and was used for the construction of the nomogram, and the predictive performance of the model was evaluated by C-index, calibration curve and ROC curve. Kaplan-Meier analysis was applied to explore the impact of HPV-related factors on patient survival, while propensity score matching (PSM) and inverse probability treatment weighting (IPTW) techniques were used to balance other confounding factors like individual clinical and pathological factors, and to evaluate the differences in overall survival (OS) and cause-specific survival (CSS) between subgroups.
RESULTS: The results indicated that histologic type, Grade classification, T/M stage, surgical methods and chemotherapy were independent risk factors affecting OS and CSS in PSCC patients. In addition, age and marital status were significantly associated with OS, while lymph node metastasis was an independent prognostic factor for CSS, the validation results of the model showed that the nomogram had a superior predictive performance compared with the American Joint Committee on Cancer staging system. In addition, subgroup analyses prior to and after IPTW and PSM adjustments showed that HPV-associated group had better OS and CSS than HPV-independent group.
CONCLUSIONS: Our study developed and validated a nomogram using a novel histologic classification and achieved satisfactory results, which can better help clinicians to predict the prognosis of penile squamous cell carcinoma patients.
摘要：
目的：本研究的目的是介绍HPV相关和HPV无关的组织学分类，以分析阴茎鳞状细胞癌（PSCC）患者的预后因素并建立预后列线图。
方法：从SEER数据库获取了2010年至2020年1502例PSCC患者的数据，将患者随机分为训练集和验证集.采用单因素和多因素COX比例风险回归分析PSCC患者预后的独立危险因素,并用于构造列线图，用C指数评价模型的预测性能，校准曲线和ROC曲线。采用Kaplan-Meier分析探讨HPV相关因素对患者生存的影响,而倾向评分匹配（PSM）和逆概率治疗加权（IPTW）技术用于平衡其他混杂因素，如个体临床和病理因素，并评估亚组之间总生存期（OS）和特定原因生存期（CSS）的差异。
结果：结果表明，组织学类型，等级分类,T/M阶段，手术方式和化疗是影响PSCC患者OS和CSS的独立危险因素。此外,年龄和婚姻状况与OS显著相关，而淋巴结转移是CSS的独立预后因素，模型的验证结果显示,与美国癌症联合委员会分期系统相比,列线图具有更好的预测性能.此外,IPTW和PSM调整前后的亚组分析显示,HPV相关组的OS和CSS优于不依赖HPV的组.
结论：我们的研究使用新的组织学分类开发并验证了列线图，并取得了令人满意的结果。能更好地帮助临床医生预测阴茎鳞状细胞癌患者的预后。
方法：从SEER数据库获取了2010年至2020年1502例PSCC患者的数据，将患者随机分为训练集和验证集.采用单因素和多因素COX比例风险回归分析PSCC患者预后的独立危险因素,并用于构造列线图，用C指数评价模型的预测性能，校准曲线和ROC曲线。采用Kaplan-Meier分析探讨HPV相关因素对患者生存的影响,而倾向评分匹配（PSM）和逆概率治疗加权（IPTW）技术用于平衡其他混杂因素，如个体临床和病理因素，并评估亚组之间总生存期（OS）和特定原因生存期（CSS）的差异。
结果：结果表明，组织学类型，等级分类,T/M阶段，手术方式和化疗是影响PSCC患者OS和CSS的独立危险因素。此外,年龄和婚姻状况与OS显著相关，而淋巴结转移是CSS的独立预后因素，模型的验证结果显示,与美国癌症联合委员会分期系统相比,列线图具有更好的预测性能.此外,IPTW和PSM调整前后的亚组分析显示,HPV相关组的OS和CSS优于不依赖HPV的组.
结论：我们的研究使用新的组织学分类开发并验证了列线图，并取得了令人满意的结果。能更好地帮助临床医生预测阴茎鳞状细胞癌患者的预后。
