Abstract
Objective: The aim of this study was to compare the competing risk model with the Cox model to evaluate prognostic markers in females with keratinized squamous cell carcinoma of the reproductive system and to develop predictive models. Methods: Patients with keratinizing squamous cell carcinoma of the female reproductive system were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Using the cumulative incidence function (CIF) and Gray's test for univariate analysis, the competing risk and Cox models were used for multivariate analysis. A nomogram was developed based on the results of the competing risk model, and the C-index, net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate the model's discrimination ability. The clinical validity of the model was assessed using calibration plots and decision curve analysis (DCA). Results: In this investigation, competing risk model analysis revealed that age, marital status, tumor size, AJCC stage, surgery, radiotherapy, chemotherapy, postoperative lymph node dissection, surgery and radiotherapy, and income were significant factors affecting the prognosis of patients with keratinizing squamous cell carcinoma of the female reproductive system. Based on these results, a nomogram for predicting the 3-year, 5-year, and 8-year survival rates was established. The nomogram demonstrated better clinical utility than the AJCC staging system. Conclusion: For the first time, the competing risk model was used in this study to assess the prognostic risk factors of keratinizing squamous cell carcinoma of the female reproductive system. The results may help clinicians make better clinical judgments. Additionally, we developed a nomogram to predict the likelihood of cancer-specific death (CSD) in patients at 3, 5, and 8 years. Physicians may use our nomogram to more accurately forecast the likelihood of CSD compared to the AJCC staging system.