Research Paper Volume 12, Issue 21 pp 22095—22111

Development and validation of prognostic nomogram for germ cell testicular cancer patients

Weipu Mao1,2, *, , Jianping Wu2, *, , Qingfang Kong3, *, , Jian Li4, , Bin Xu2, , Ming Chen2, ,

  • 1 Department of Urology, People’s Hospital of Putuo, Shanghai 200060, China
  • 2 Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, China
  • 3 Department of Nosocomial Infection, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, China
  • 4 Department of Urology, The People’s Hospital of Jinhu, Huaian 211600, Jiangsu Province, China
* Equal contribution

Received: July 15, 2020       Accepted: August 26, 2020       Published: November 2, 2020
How to Cite

Copyright: © 2020 Mao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


The purpose of our study was to establish a reliable and practical nomogram based on significant clinical factors to predict the overall survival (OS) and cancer-specific survival (CSS) of patients with germ cell testicular cancer (GCTC). Patients diagnosed with GCTC between 2004 and 2015 were obtained from the SEER database. Nomograms were constructed using the R software to predict the OS and CSS probabilities and the constructed nomograms were validated and calibrated. A total of 22,165 GCTC patients were enrolled in the study, including the training cohort (15,515 patients) and the validation cohort (6,650 patients). In the training cohort, multivariate Cox regression showed that age, race, AJCC stage, SEER stage and surgery were independent prognostic factors for OS, while age, race, AJCC stage, TM stage, SEER stage and radiotherapy were independent prognostic factors for CSS. Based on the above Cox regression results, we constructed prognostic nomograms of OS and CSS in GCTC patients and found that the OS nomograms had higher C-index and AUC compared to TNM stage in the training and validation cohorts. In addition, in the training and external validation cohorts, the calibration curves showed a good consistency between the predicted and actual 3-, 5- and 10-year OS and CSS rates of the nomogram. The current prognostic nomogram can provide a personalized risk assessment for the survival of GCTC patients.


GCTC: Germ cell testicular cancer; SEER: Surveillance, Epidemiology, and End Results; OS: Overall survival; CSS: Cancer-specific survival; C-index: Consistency index; DCA: Decision curve analysis; AJCC: American Joint Committee on Cancer; TNM: Tumor node metastasis; ICD-O: The International Classification of Diseases for Oncology; ROC: Receiver operating characteristic; AUC: Area under the curve; CIC: Clinical impact curve; HR: Hazard ratios; CI: Confidence intervals.