| BackgroundRhabdomyosarcoma(RMS)is a malignant tumor formed by skeletal muscle cells at different stages of differentiation,accounting for 3%of adult soft tissue sarcomas.Rhabdomyosarcoma of the genitourinary system is more common in children and adolescents,and the incidence of men is significantly higher than that of women.RMS originates from the primitive mesenchyme,the most common site of occurrence is the head and neck,followed by the genitourinary system.Approximately 15%to 20%of RMS comes from the genitourinary system(GU),including the female genitals(vagina,uterus,cervix),bladder,prostate,and testes.Among them,female genital RMS is the most rare,but compared with other genitourinary system RMS,its survival rate is higher.Due to the lack of specific clinical manifestations and the different degrees of primary tumor compression and invasion of surrounding organs and tissues,RMS patients often exhibit different symptoms,which are usually manifested as rapidly growing masses.The symptoms are related to the location and depth of tumor invasion.The main treatment methods for RMS include chemotherapy,surgery and radiation therapy.RMS is characterized by poor prognosis and unclear prognostic factors.Since 1972,the International Rhabdomyosarcoma Research Group(IRSG)has published a series of treatment guidelines for different primary sites through clinical trials,increasing the long-term survival rate of RMS patients from about 25%in 1970 to 70%in the 1990s Above,an increase of nearly three times.However,in my country,due to the large differences in the medical level between regions,and some patients with RMS see a doctor late,there is still a certain gap between the overall survival of RMS and the international level.Individualized prognostic estimation is very useful for cancer patients to choose treatment methods and optimize treatment methods.At present,there are few clinical studies on urinary and reproductive system rhabdomyosarcoma,and most of them are case reports.There is no predictive tool based on urinary and reproductive system rhabdomyosarcoma.This study is based on the National Cancer Institute(NCI)Surveillance,Epidemiology,and Outcomes(SEER)database to collect population data.The database collects cancer incidence and survival data since 1973.It is an analysis of urinary and reproductive System RMS is an ideal database for rare tumors.Based on this,we analyzed the overall survival(OS)time of RMS in the urinary and reproductive systems,and constructed a nomogram to predict this disease,which can provide clinicians and patients with a practical predictive tool.ObjectiveThis study aims to analyze the relevant factors that affect the prognosis of rhabdomyosarcoma in the urinary and reproductive system,and construct a nomogram to predict overall survival time,so as to provide clinicians and patients with a practical predictive tool.Methods1.Collect patient data in the SEER database(15912-Nov2019)through SEER*Stat(version 8.3.8)software.990 patients with rhabdomyosarcoma of the urinary and reproductive system who were pathologically diagnosed from January 1,1975 to December 31,2016 were included in this study.2.Extract the patient’s age,gender,race,tumor location,pathological type,tumor size,total stage,pathological grade,TNM stage and treatment method(surgery,radiotherapy,chemotherapy)from the SEER database,and determine the patient’s IRSG classification.Use X-tile(version 3.6.1)software to determine the best age cut-off value for prognostic analysis,and use age as a categorical variable for analysis.Univariate and multivariate Cox regression analysis were used to screen independent risk factors for urinary and reproductive system rhabdomyosarcoma.3.According to the independent risk factors screened out by the Cox proportional hazard model,the R software is used to construct the nomogram prediction model,the bootstrap method is used for internal sampling(number of times=1000),and the bootstrap adjusted C index is used to evaluate the nomogram Prediction accuracy,by drawing a calibration curve to evaluate the consistency of the prediction model.Results1.Use the X-tile software to determine the best age cut-off value for prognostic analysis.The results show that the best cut-off value for age is 22 years old and 62 years old,and divided into 0-22 years old group and 23-62 years old group And≥63 years old group.2.The univariate analysis results show that age,gender,tumor location,pathological type,tumor size,total stage,pathological grade,N classification,M classification,surgery,chemotherapy,and IRSG grading system are all important for rhabdomyosarcoma of the urinary and reproductive system Influencing factors(P<0.05),while race and radiotherapy have no correlation with the prognosis of urinary and reproductive system rhabdomyosarcoma(P>0.05).Multivariate Cox proportional hazard regression model analysis showed that the patient’s age,tumor location,pathological type,tumor size,total stage,N classification,M classification,surgery,and chemotherapy are all independent of the prognosis of patients with urinary and reproductive system rhabdomyosarcoma.Risk factors.3.The nomogram prediction model of urinary and reproductive system rhabdomyosarcoma was successfully constructed.The result of internal verification shows:C index=0.841,indicating that this nomogram has good prediction accuracy.The calibration curve drawn by this model shows that the predicted 1-year,3-year,and 5-year survival rates are close to the reference line and have good consistency.Conclusion1.Age,tumor site,pathological type,tumor size,overall stage,N classification,M classification,surgery,and chemotherapy were independent risk factors affecting the prognosis of rhabdomyosarcoma of the urinary and genital system.The older the patient,the worse the prognosis;among the tumor sites,vulvovaginal and testicular were among the sites with good prognosis,while bladder,prostate,and kidney had poorer prognosis;among the tumor pathological types,adenoidal RMS had worse prognosis compared with embryonic type;compared with patients with tumor diameter ≤5 cm,patients with diameter>5 cm had worse prognosis;compared with patients with negative lymph node metastasis,positive patients had The prognosis was worse in patients with positive lymph node metastases compared with negative lymph node metastases;worse in patients with distant metastases compared with patients without distant metastases;worse in patients without surgery compared with patients treated with surgery;and worse in patients without chemotherapy compared with patients treated with chemotherapy.2.A relatively accurate and well-established line chart for the prognosis of patients with rhabdomyosarcoma of the urinary and genital systems was successfully constructed based on nine factors:age,tumor site,pathological type,tumor size,overall stage,N classification,M classification,surgery,and chemotherapy,providing a visual and scaled assessment tool for the survival assessment of patients with rhabdomyosarcoma of the urinary and genital systems... |
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