Prognostic And Risk Factors Of Distant Metastasis In Nonseminomatous Germ Cell Tumors(NSGCT) And Construction Of Prediction Models

Background:Distant metastasis is a common complication of nonseminomatous germ cell tumors(NSGCT),which often leads to poor prognosis.Although the SEER database and nomogram have been widely used in the field of oncology,no studies have focused on the diagnosis and prognosis evaluation of patients with distant metastasis of NSGCT.This study was designed to develop a model to predict the risk of distant metastasis in nonseminomatous germ cell tumors and to evaluate the prognosis of patients with distant metastasis.Methods:Data on patients with nonseminomatous germ cell tumors diagnosed between 2010 and 2015 were extracted from the Surveillance,Epidemiology,and End Results(SEER)database.Firstly,all included patients were divided into training set and validation set by 7:3.Univariate and multivariate Cox regression analysis were used to determine the prognostic factors of distant metastasis in patients with nonseminomatous germ cell tumors.Univariate and multivariate logistic regression analysis were used to determine the independent risk factors of distant metastasis in patients with nonseminomatous germ cell tumors.Then,a nomogram model was constructed based on these significant factors and verified in the validation set.The results were evaluated by drawing the receiver operating characteristic(ROC)curve and calibration curve.Results:Multivariate Cox regression analysis showed that age,radiotherapy,surgery,chemotherapy,(brain metastasis),liver metastasis and lung metastasis were significantly associated with the prognosis of patients with distant metastasis.Based on these factors,the C-index of OS model was 0.715 in the training cohort and 0.756 in the test cohort,and the C-index of CSS model was 0.708 in the training cohort and 0.759 in the test cohort.Multivariate Logistic regression analysis showed that tumor side,T stage,N stage and histological type were risk factors for distant metastasis in patients with NSGCT.Based on these factors,the C-index of the model predicting distant metastasis was 0.815 in the training cohort and 0.802 in the test cohort.Conclusion:The prediction model we constructed is an effective tool for surgeons to assess the risk of distant metastasis in NSGCT patients and to evaluate the survival prognosis of patients with distant metastasis,which will help in clinical decision making.