Population-Based analysis of conditional survival patterns and dynamic prognostic modeling in primary urinary tract...

Primary urinary tract lymphoma (PUTL) is a rare subtype of extranodal lymphoma, with current knowledge largely limited to case reports and small series. This study aimed to evaluate the dynamic survival patterns of PUTL using conditional survival (CS) analysis and to develop a prognostic nomogram for individualized survival prediction.

Patients diagnosed with PUTL between 2000 and 2021 were identified from the SEER database. CS estimates and annual hazard rates were calculated to assess time-dependent changes in survival probability and risk of death. A prognostic model was constructed using variables selected by Random Survival Forest (RSF) and multivariate Cox regression. A CS-nomogram was developed and validated to predict 3-, 5-, and 10-year overall survival (OS) and 10-year conditional survival.

A total of 1,201 patients were included. CS analysis showed that long-term survival probabilities improved significantly with each additional year survived. The highest mortality risk occurred in the first year after diagnosis, followed by a rapid decline and stabilization after three years. Factors such as age, tumor histology, stage, and treatment modalities were identified as significant predictors of OS. The CS-nomogram demonstrated good calibration and discrimination, with AUCs of 0.740, 0.733, and 0.800 for 3-, 5-, and 10-year OS in the training set, and 0.712, 0.708, and 0.794 in the validation set, respectively. Decision curve analysis indicated favorable clinical utility.

This study provides the most comprehensive dynamic survival assessment of PUTL to date. CS analysis revealed a favorable shift in prognosis over time, particularly for patients who survived the high-risk early phase. The CS-nomogram enables personalized, time-updated prognostic estimates, supporting more accurate counseling, follow-up planning, and resource optimization in this rare disease.