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. 2022 Oct 27:12:973579.
doi: 10.3389/fonc.2022.973579. eCollection 2022.

Nomograms for predicting the prognosis of patients with penoscrotal extramammary Paget's disease: A retrospective study in the SEER database and two medical centers

Le-Bin Song  1 , Xiang Zhou  2 , Jiao-Chen Luan  2 , Hao-Yang Wang  1 , Xue-Chen Cao  1 , Jia-Wei Lu  1 , Yu-Jie Zheng  1 , Xin-Feng Wu  3 , Yan Lu  1
Affiliations

Nomograms for predicting the prognosis of patients with penoscrotal extramammary Paget's disease: A retrospective study in the SEER database and two medical centers

Le-Bin Song et al. Front Oncol. .

Abstract

Background: Extramammary Paget' s disease (EMPD) is a rare cutaneous malignant tumor, and the prognostic factors associated with penoscrotal EMPD remains unclear. The purpose of this study is to investigate prognostic factors and construct nomograms to predict the outcome of patients with EMPD located in the penis or scrotum.

Methods: From the Surveillance, Epidemiology and End Results (SEER) database, we extracted 95 patients with primary EMPD located in the penis or scrotum as the training cohort. Forty-nine penoscrotal EMPD patients were included from two medical centers as the external validation cohort. Univariate and multivariate Cox regression model were applied to investigating risk factors of cancer-specific survival (CSS) and overall survival (OS). Based on the results of multivariate Cox regression analysis, the nomograms were constructed for predicting CSS and OS of patients with penoscrotal EMPD. The concordance index (C-index), receiver operating characteristic (ROC) curves and calibration curves were applied to evaluate the practicability and accuracy of the nomograms.

Results: In the training cohort, multivariate Cox regression analysis showed that marital status and tumor stage were independent factors of CSS, and marital status, tumor stage and surgery are associated with OS independently in patients with penoscrotal EMPD. Based on these results, we developed nomograms to predict CSS and OS respectively. The C-index values were 0.778 for CSS, and 0.668 for OS in the training set, which displayed the good discriminations. In the external validation set, the C-index values were 0.945 for CSS, and 0.703 for OS. The areas under the curve (AUC) values of nomogram predicting 1-, 3-, and 5-year CSS were 0.815, 0.833, and 0.861 respectively, and 0.839, 0.654, and 0.667 for nomogram predicting 1-, 3-, and 5-year OS respectively. In the validation set, the AUC values of nomogram predicting 1-, 3-, and 5-year CSS were 0.944, 0.896, and 0.896 respectively, and 0.777, 0.762 and 0.692 for nomogram predicting 1-, 3-, and 5-year OS respectively. Additionally, the internal calibration curves also proved that our nomograms have good accuracy.

Conclusions: By incorporating marital status, tumor stage and/or surgery, our nomograms can efficiently predict CSS and OS of patients with penoscrotal EMPD.

Keywords: SEER; external validation; nomogram; penoscrotal extramammary Paget’s disease; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of patients with penoscrotal EMPD enrollment from SEER database.
Figure 2
Figure 2
Kaplan–Meier curves of CSS for patients with penoscrotal EMPD stratified by marital status (A, B) and SEER historic stage A (C, D) in thetraining cohort and validation cohort respectively.
Figure 3
Figure 3
Kaplan–Meier curves of OS for patients with penoscrotal EMPD stratified by marital status (A, B), SEER historic stage A (C, D) and surgery (E, F) in the training cohort and validation cohort respectively.
Figure 4
Figure 4
The nomogram for predicting 1-year, 3-year, and 5-year CSS of patients with penoscrotal EMPD.
Figure 5
Figure 5
The nomogram for predicting 1-year, 3-year, and 5-year OS of patients with penoscrotal EMPD.
Figure 6
Figure 6
The ROC curves of the nomogram predicting 1-year, 3-year, and 5-year (A) CSS and (B) OS in the training cohort.
Figure 7
Figure 7
The ROC curves of the nomogram predicting 1-year, 3-year, and 5-year (A) CSS and (B) OS in the validation cohort.
Figure 8
Figure 8
The calibration curves of the nomogram predicting 1-year, 3-year, and 5-year (A) CSS and (B) OS in the training cohort.
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