■睾丸生殖细胞肿瘤(TGCT)是年轻男性中最常见的恶性肿瘤,但很少在老年人中。我们旨在构建一个竞争风险模型来预测老年TGCT患者的预后。
■我们从国家癌症研究所的监测收集了2004年至2015年间诊断为50岁或以上的TGCT患者,流行病学,和结束结果(SEER)数据库。我们估计了原因特异性死亡(CSD)和其他死亡原因的累积发生率,并通过Fine-Gray竞争风险回归建立了预测老年TGCT患者原因特异性死亡率的列线图。一致性指数(C指数),校正曲线,接收器工作特性曲线下面积(AUC),和决策分析曲线(DCA)用于评估差异,准确度,列线图的临床意义。
■共有2,751例老年TGCT患者纳入研究。3、5-,10年累计发病率分别为4.4%、5.0%和6.1%,分别,对于特定原因的死亡,和3.8,6.2,13.1%,分别,其他死亡原因。老年TGCT病因特异性死亡率的预测因素包括年龄,婚姻状况,家庭年收入,组织学,肿瘤大小,阶段和手术。在训练集和验证集中,C指数大于0.8,表明列线图具有良好的区分度。AUC显示了相同的结果。校准曲线显示出诺模图的预测和观察结果之间的良好一致性。DCA曲线表明,列线图比传统的美国癌症联合委员会(AJCC)分期更具临床意义。根据每个案例的总列线图得分,所有患者分为低风险和高风险组,和风险分类允许识别具有高死亡风险的病例。
■我们建立了具有良好表现的竞争性风险列线图,可能有助于临床医生准确预测老年TGCT患者的预后。
UNASSIGNED: Testicular germ cell tumor (TGCT) is the most common type of malignancy in young men, but rarely in older adults. We aimed to construct a competing risk model to predict the prognosis for older patients with TGCT.
UNASSIGNED: We collected TGCT patients aged 50 years or older diagnosed between 2004 and 2015 from the National Cancer Institute\'s Surveillance, Epidemiology, and End Results (SEER) database. We estimated the cumulative incidences of cause-specific death (CSD) and other causes of death and established a nomogram predicting cause-specific mortality in older patients with TGCT by Fine-Gray competing risk regression. The concordance index (C-index), calibration curves, area under the receiver operating characteristic curve (AUC), and decision analysis curves (DCA) were used to evaluate the differentiation, accuracy, and clinical significance of the nomogram.
UNASSIGNED: A total of 2,751 older TGCT patients were included in the study. The 3-, 5-, and 10-year cumulative incidences were 4.4, 5.0 and 6.1%, respectively, for cause-specific death, and 3.8, 6.2, 13.1%, respectively, for other causes of death. Predictors of cause-specific mortality in older TGCT included age, marital status, annual household income, histology, tumor size, stage and surgery. In the training and validation sets, the C-indexes were greater than 0.8, indicating that the nomogram had good discrimination. The AUC revealed the same result. The calibration curves showed good agreement between the predicted and observed results of the nomogram. DCA curves indicated that the nomogram had more clinical significance than the conventional American Joint Committee on Cancer (AJCC) staging. Based on the total nomogram score of each case, all patients were categorized into low-risk and high-risk groups, and risk categorization allowed the identification of cases with a high risk of death.
UNASSIGNED: We established a competing risk nomogram with good performance that may help clinicians accurately predict the prognosis of older TGCT patients.