Development and external clinical validation of a histology-inclusive prognostic nomogram for vulvar cancer based on the Surveillance, Epidemiology, and End Results database.
4 affiliations
- 1Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
- 2College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.
- 3Department of Radiation Oncology, Fudan University Shanghai Cancer Center Xiamen Hospital, Xiamen, China.
- 4Department of Urology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
Abstract
Vulvar carcinoma is a rare gynecological malignancy with rising incidence and suboptimal survival outcomes. Most existing prognostic nomograms for vulvar cancer are restricted to squamous-cell histology and lack cross-ethnic external validation, which creates an unmet clinical need for risk-stratification tools covering diverse histological subtypes. The Surveillance, Epidemiology, and End Results (SEER) registry provides large-scale population-based real-world clinicopathological and survival data across multiple histologic subtypes, making it suitable for deriving a new prognostic model. This study sought to develop and internally- and externally-validate a histology-inclusive prognostic nomogram for overall survival (OS) in patients with vulvar cancer. Patients diagnosed with invasive vulvar carcinoma between 2010-2022 were abstracted from the SEER registry. Eligible subjects were aged ≥18 years with pathological confirmation, complete survival follow-up, and non-missing key candidate predictors. Patients with synchronous primary malignancies were excluded. Variables encompassed age, histological subtype, grade, tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage, surgery, chemotherapy, radiotherapy. The SEER cohort was randomly split at a 7:3 ratio into training (n=3,555) and internal-validation (n=1,524) datasets. An independent cohort (n=144) from Fujian Provincial Cancer Hospital served for external validation. OS was defined as time from pathological diagnosis to all-cause death or last follow-up contact. Survival information was obtained from registry linkage for SEER and from hospital medical records plus telephone follow-up for the external cohort. Cox proportional hazards modeling identified independent prognostic determinants, which were integrated into a nomogram. Model discrimination was assessed via Harrell's concordance index (C-index) and time-dependent area under the receiver operating characteristic curve (AUC); calibration was evaluated graphically; clinical utility was evaluated by decision curve analysis (DCA). A risk-stratification system was derived from the prognostic index (PI). A total of 5,079 SEER patients (training cohort: n=3,555, events =1,378; internal-validation cohort: n=1,524, events =573) and 144 external-validation patients (events =40) were analyzed. Baseline characteristics of the three cohorts were summarized. Neither histological subtype nor adjuvant radiotherapy emerged as an independent survival predictor. The nomogram demonstrated acceptable discrimination, with C-index values of 0.776, 0.768, and 0.822 across the training, internal-validation and external-validation cohorts, alongside favorable 1-, 3-, and 5-year time-dependent AUC values. Calibration curves indicated acceptable agreement between predicted and observed probabilities. The Brier scores of the training, internal-validation and external-validation cohorts were 0.0927, 0.0932 and 0.0622, respectively; all calibration slopes were close to 1 and intercepts close to 0. DCA confirmed positive net clinical benefit. The risk-stratification system effectively distinguished patients with divergent survival trajectories. This externally-validated nomogram showed acceptable prognostic performance for risk stratification in vulvar-cancer patients. Further multi-center and multi-ethnic external validations are required before routine clinical application to optimize therapeutic decision-making in vulvar cancer.
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BibTeX
@article{ke2026development,
title = {{Development and external clinical validation of a histology-inclusive prognostic nomogram for vulvar cancer based on the Surveillance, Epidemiology, and End Results database.}},
author = {Hongqian Ke and Ning Xie and Qian Wu and Bin Zhan},
journal = {Translational cancer research},
year = {2026},
month = sep,
doi = {10.21037/tcr-2026-1448},
url = {https://europepmc.org/article/MED/42997915},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Development and external clinical validation of a histology-inclusive prognostic nomogram for vulvar cancer based on the Surveillance, Epidemiology, and End Results database.
AU - Hongqian Ke
AU - Ning Xie
AU - Qian Wu
AU - Bin Zhan
PY - 2026
DA - 2026/09/28
JO - Translational cancer research
DO - 10.21037/tcr-2026-1448
UR - https://europepmc.org/article/MED/42997915
AB - Vulvar carcinoma is a rare gynecological malignancy with rising incidence and suboptimal survival outcomes. Most existing prognostic nomograms for vulvar cancer are restricted to squamous-cell histology and lack cross-ethnic external validation, which creates an unmet clinical need for risk-stratification tools covering diverse histological subtypes. The Surveillance, Epidemiology, and End Results (SEER) registry provides large-scale population-based real-world clinicopathological and survival data across multiple histologic subtypes, making it suitable for deriving a new prognostic model. This study sought to develop and internally- and externally-validate a histology-inclusive prognostic nomogram for overall survival (OS) in patients with vulvar cancer. Patients diagnosed with invasive vulvar carcinoma between 2010-2022 were abstracted from the SEER registry. Eligible subjects were aged ≥18 years with pathological confirmation, complete survival follow-up, and non-missing key candidate predictors. Patients with synchronous primary malignancies were excluded. Variables encompassed age, histological subtype, grade, tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage, surgery, chemotherapy, radiotherapy. The SEER cohort was randomly split at a 7:3 ratio into training (n=3,555) and internal-validation (n=1,524) datasets. An independent cohort (n=144) from Fujian Provincial Cancer Hospital served for external validation. OS was defined as time from pathological diagnosis to all-cause death or last follow-up contact. Survival information was obtained from registry linkage for SEER and from hospital medical records plus telephone follow-up for the external cohort. Cox proportional hazards modeling identified independent prognostic determinants, which were integrated into a nomogram. Model discrimination was assessed via Harrell's concordance index (C-index) and time-dependent area under the receiver operating characteristic curve (AUC); calibration was evaluated graphically; clinical utility was evaluated by decision curve analysis (DCA). A risk-stratification system was derived from the prognostic index (PI). A total of 5,079 SEER patients (training cohort: n=3,555, events =1,378; internal-validation cohort: n=1,524, events =573) and 144 external-validation patients (events =40) were analyzed. Baseline characteristics of the three cohorts were summarized. Neither histological subtype nor adjuvant radiotherapy emerged as an independent survival predictor. The nomogram demonstrated acceptable discrimination, with C-index values of 0.776, 0.768, and 0.822 across the training, internal-validation and external-validation cohorts, alongside favorable 1-, 3-, and 5-year time-dependent AUC values. Calibration curves indicated acceptable agreement between predicted and observed probabilities. The Brier scores of the training, internal-validation and external-validation cohorts were 0.0927, 0.0932 and 0.0622, respectively; all calibration slopes were close to 1 and intercepts close to 0. DCA confirmed positive net clinical benefit. The risk-stratification system effectively distinguished patients with divergent survival trajectories. This externally-validated nomogram showed acceptable prognostic performance for risk stratification in vulvar-cancer patients. Further multi-center and multi-ethnic external validations are required before routine clinical application to optimize therapeutic decision-making in vulvar cancer.
SN - 2218-676X
SN - 2219-6803
ER -