Clinical Characteristics, Risk Classification System, and Web-Based Nomograms for Young and Middle-Aged Patients (Aged Under 50) with Metastatic Cervical Cancer: Based on Seer Database

Abstract

Background: Currently, there is a lack of systematic research on the prognostic variables of metastatic cervical cancer (mCEC) among young and middle-aged females. Therefore, this research is purposed to identify the independent prognostic markers in mCEC patients (< 50 years of age) and to develop the nomograms applicable to predict their prognosis. Materials and Methods: The data on patients pathologically proven to have cervical cancer between 2004 and 2015 were collected from the American detection, epidemiology, and results (SEER) database. Then, univariate and multivariate cox analyses were conducted to determine independent prognostic variables. On this basis, nomograms were constructed to predict the 12-, 24-, and 36-month overall survival (OS) of mCEC patients aged under 50. The model was evaluated for predictive accuracy, discriminant ability, and clinical value through the receiver operating characteristic curve, the calibration curve and the decision-making curve analysis. Additionally, a survival calculator based on nomogram and network was developed. Results: A total of 616 mCEC patients aged under 50 were involved in the research. They were divided into a training set (419) and a validation set (176), at a ratio of 7:3. The independent predictive markers include race, tumour size, T stage, chemotherapy, radiotherapy, and surgery. According ot the analysis of the calibration curve, receiver operating characteristic curve, and decision curve plotted for both the training and validation cohorts, the NOMOGRAMS was highly discriminative and applicable clinically. The AUC value at 12, 24, and 36 months was 0.741, 0.739, and 0.731 in the training set, and 0.760, 0.695, and 0.696 in the validation set, respectively. The nomograms proposed in this paper can be accessed via the link: [https://shubei11.shinyapps.io/Youngcervicalnomogram/.](https://shubei11.shinyapps.io/Youngcervicalnomogram/.) In addition, a method novel risk categorization was developed to categorise all patients into three groups depending on their prognosis. Conclusions: In this study, a unique web-based nomogram is developed to estimate the risk of OS among the young and middle-aged mCEC patients (< 50), which would be beneficial for clinicians to personalise both survival evaluation and therapeutic treatment for patients.