Based on the surveillance, epidemiology, and end results programme, to develop and validate nomograms for predicting overall survival and cancer-specific survival in geriatric patients with vulvar squamous cell carcinoma

This study aimed to develop and validate nomograms for improving overall survival (OS) and cancer-specific survival (CSS) predictions in elderly patients diagnosed with vulvar squamous cell carcinoma (VSCC). Data from the Surveillance, Epidemiology, and End Results (SEER) database were retrieved to gather information on VSCC patients aged 60 years and older. Univariate and multivariate Cox regression analyses were conducted to identify independent risk factors. Based on these factors, nomograms were constructed to predict patients’ OS and CSS. Model accuracy and discriminative power were assessed using the concordance index (C-index), area under the receiver operating characteristic curve (AUC), and calibration curves. Decision curve analysis (DCA) was also employed to assess the clinical significance of the proposed nomograms in comparison to the TNM (Tumor Node Metastasis) and AJCC (American Joint Committee on Cancer) staging systems. Between 2000 and 2019, a total of 2736 elderly VSCC patients met the inclusion criteria and were randomly divided into two groups: a training set (N = 1927) and a validation set (N = 809). Independent risk factors for predicting OS included age, grade, summary stage, T stage, N stage, primary site surgery, chemotherapy, regional node status and tumor size. For predicting CSS, independent risk factors were age, summary stage, AJCC stage, T stage, N stage, primary site surgery, chemotherapy, regional node status and tumor size. The C-index for OS in the training and validation sets was 0.724 (95% CI: 0.710–0.738) and 0.73 (95% CI: 0.708–0.752), respectively. In contrast, for CSS prediction, the C-index was 0.758 (95% CI: 0.740–0.776) in the training set and 0.774 (95% CI: 0.749–0.799) in the validation set. The proposed nomograms for predicting OS and CSS in VSCC patients aged 60 and older demonstrate promising potential as reliable tools that clinicians can consider to make more informed therapeutic decisions.

Nomogram; Geriatric; Vulvar squamous cell carcinoma cancer; OS; CSS; SEER

[1] Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA: A Cancer Journal for Clinicians. 2022; 72: 7–33.

[2] Garganese G, Inzani F, Fragomeni SM, Mantovani G, Della Corte L, Piermattei A, et al. The vulvar immunohistochemical panel (VIP) project: molecular profiles of vulvar squamous cell carcinoma. Cancers. 2021; 13: 6373.

[3] Mancini S, Bucchi L, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, et al. Incidence trends of vulvar squamous cell carcinoma in Italy from 1990 to 2015. Gynecologic Oncology. 2020; 157: 656–663.

[4] Chow L, Tsui BQ, Bahrami S, Masamed R, Memarzadeh S, Raman SS, et al. Gynecologic tumor board: a radiologist’s guide to vulvar and vaginal malignancies. Abdominal Radiology. 2021; 46: 5669–5686.

[5] Merlo S. Modern treatment of vulvar cancer. Radiology and Oncology. 2020; 54: 371–376.

[6] Virarkar M, Vulasala SS, Daoud T, Javadi S, Lall C, Bhosale P. Vulvar cancer: 2021 Revised FIGO staging system and the role of imaging. Cancers. 2022; 14: 2264.

[7] Shin DW, Bae J, Ha J, Lee WM, Jung K. Trends in incidence and survival of patients with vulvar cancer in an Asian country: analysis of the Korean Central cancer registry 1999–2018. Gynecologic Oncology. 2022; 164: 386–392.

[8] Verri D, Moro F, Fragomeni SM, Zaçe D, Bove S, Pozzati F, et al. The role of ultrasound in the evaluation of inguinal lymph nodes in patients with vulvar cancer: a systematic review and meta-analysis. Cancers. 2022; 14: 3082.

[9] Khullar K, Patrich T, Jabbour SK, Hathout L. Adjuvant radiation in early stage vulvar cancer: a review of indications and optimal dose. Applied Radiation Oncology. 2022; 11: 14–20.

[10] Santoro A, Angelico G, Travaglino A, Inzani F, Arciuolo D, Valente M, et al. Prognostic role of perineural invasion in vulvar squamous cell carcinoma: a systematic review and meta-analysis. European Journal of Surgical Oncology. 2022; 48: 2354–2359.

[11] Weinberg D, Gomez-Martinez RA. Vulvar cancer. Obstetrics and Gynecology Clinics of North America. 2019; 46: 125–135.

[12] Matsuo K, Klar M, Nishio S, Mikami M, Roman LD, Wright JD. Validation of the 2021 FIGO staging schema for advanced vulvar cancer. International Journal of Gynecologic Cancer. 2022; 32: 474–479.

[13] Olawaiye AB, Cuello MA, Rogers LJ. Cancer of the vulva: 2021 update. International Journal of Gynecology & Obstetrics. 2021; 155: 7–18.

[14] Olawaiye AB, Cotler J, Cuello MA, Bhatla N, Okamoto A, Wilailak S, et al. FIGO staging for carcinoma of the vulva: 2021 revision. International Journal of Gynecology & Obstetrics. 2021; 155: 43–47.

[15] Mao Y, He M, Tang Z, Chen M, Wu L, Liang T, et al. Prognostic nomograms to predict overall survival and cause specific death in vulvar squamous cell carcinoma. International Journal of Gynecologic Cancer. 2022; 32: 706–715.

[16] Zhou W, Yue Y. Developing and validating novel nomograms for predicting the overall survival and cancer-specific survival of patients with primary vulvar squamous cell cancer. Frontiers in Medicine. 2021; 8: 777605.

[17] Lei L, Tan L, Zhao X, Zeng F, Xu D. A prognostic nomogram based on lymph node ratio for postoperative vulvar squamous cell carcinoma from the surveillance, epidemiology, and end results database: a retrospective cohort study. Annals of Translational Medicine. 2020; 8: 1382–1382.

[18] Liu J, Wang M. Development and validation of nomograms predicting cancer‐specific survival of vulvar cancer patients: based on the surveillance, epidemiology, and end results program. International Journal of Gynecology & Obstetrics. 2022; 156: 529–538.

[19] Scampa M, Kalbermatten DF, Oranges CM. Squamous cell carcinoma of the vulva: a survival and epidemiologic study with focus on surgery and radiotherapy. Journal of Clinical Medicine. 2022; 11: 1025.

[20] Zippin C, Lum D, Hankey BF. Completeness of hospital cancer case reporting from the SEER program of the national cancer institute. Cancer. 1995; 76: 2343–2350.

[21] Wang X, Lu J, Song Z, Zhou Y, Liu T, Zhang D. From past to future: bibliometric analysis of global research productivity on nomogram (2000–2021). Frontiers in Public Health. 2022; 10: 997713.

[22] Zheng W, Zhu W, Yu S, Li K, Ding Y, Wu Q, et al. Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma. BMC Cancer. 2020; 20: 1066.

[23] Zhang Z, Zhanghuang C, Wang J, Tian X, Wu X, Li M, et al. Development and validation of nomograms to predict cancer-specific survival and overall survival in elderly patients with prostate cancer: a population-based study. Frontiers in Oncology. 2022; 12: 918780.

[24] Micheletti L, Borella F, Preti M, Frau V, Cosma S, Privitera S, et al. Perineural invasion in vulvar squamous-cell carcinoma is an independent risk factor for cancer-specific survival, but not for locoregional recurrence: results from a single tertiary referral center. Cancers. 2021; 14: 124.

[25] Camp RL, Dolled-Filhart M, Rimm DL. X-tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization. Clinical Cancer Research. 2004; 10: 7252–7259.

[26] Julia CJ, Hoang L. A review of prognostic factors in squamous cell carcinoma of the vulva: evidence from the last decade. Seminars in Diagnostic Pathology. 2021; 38: 37–49.

[27] Prieske K, Woelber L, Muallem MZ, Eulenburg C, Jueckstock JK, Hilpert F, et al. Age, treatment and prognosis of patients with squamous cell vulvar cancer (VSCC)—analysis of the AGO-CaRE-1 study. Gynecologic Oncology. 2021; 161: 442–448.

[28] Hellman K, Holmberg E, Bjurberg M, Borgfeldt C, Dahm-Kähler P, Flöter Rådestad A, et al. Primary treatment and relative survival by stage and age in vulvar squamous cell carcinoma: a population-based SweGCG study. Gynecologic Oncology. 2020; 159: 663–671.

[29] Pedrão PG, Guimarães YM, Godoy LR, Possati-Resende JC, Bovo AC, Andrade CEMC, et al. Management of early-stage vulvar cancer. Cancers. 2022; 14: 4184.

[30] Rogers LJ. Management of advanced squamous cell carcinoma of the vulva. Cancers. 2021; 14: 167.

[31] Mokhtech M, Gao SJ, Kassick M, Menderes G, Damast S. Declining use of inguinofemoral lymphadenectomy in the treatment of clinically negative, pathologic node positive vulvar cancer. Gynecologic Oncology. 2022; 166: 61–68.

[32] Scampa M, Kalbermatten DF, Oranges CM. Squamous cell carcinoma of the vulva: a survival and epidemiologic study with focus on surgery and radiotherapy. Journal of Clinical Medicine. 2022; 11: 1025.