Preoperative nomogram for the identification of lymph node metastasis in early cervical cancer

Abstract

Background:The objective of this study is to construct a preoperative nomogram predicting lymph node metastasis (LNM) in early-cervical cancer patients.Methods:Between 2009 and 2012, 493 early-cervical cancer patients received hysterectomy and pelvic/para-aortic lymphadenectomy. Patients who were diagnosed during 2009–2010 were assigned to a model-development cohort (n=304) and the others were assigned to a validation cohort (n=189). A multivariate logistic model was created from preoperative clinicopathologic data, from which a nomogram was developed and validated. A predicted probability of LNM<5% was defined as low risk.Results:Age, tumour size assessed by magnetic resonance imaging, and LNM assessed by positron emission tomography/computed tomography were independent predictors of nodal metastasis. The nomogram incorporating these three predictors demonstrated good discrimination and calibration (concordance index=0.878; 95% confidence interval (CI), 0.833−0.917). In the validation cohort, the discrimination accuracy was 0.825 (95% CI, 0.736−0.895). In the model-development cohort, 34% of them were classified as low risk and negative predictive value (NPV) was 99.0%. In the validation cohort, 38% were identified as low risk and NPV was 95.8%. Integrating the model-development and validation cohorts, negative likelihood ratio was 0.094 (95% CI, 0.036−0.248).Conclusion:A robust nomogram predicting LNM in early cervical cancer was developed. This model may improve clinical trial design and help physicians to decide whether lymphadenectomy should be performed.

Routine Intraoperative Frozen Section Examination to Minimize Bimodal Treatment in Early-Stage Cervical Cancer

“…In support of this, a robust model, which accurately identified patients with early cervical cancer at low risk for nodal metastases, has been recently developed and validated. 22 It is of note that 3 (23%) of 13 patients were incorrectly classified as low risk by our regression model. In another study, low risk has been defined as a predicted probability of developing nodal metastasis of 5%.…”

Prognostic models for locally advanced cervical cancer: external validation of the published models

“…The structure of both reviews has elements in common with the one presented here and with the proposal found in the Cochrane manual of systematic reviews of interventions [ 38 ]. Other works present validation analyses of prognostic models in patients with early cervical cancer [ 39 ], LACC [ 17 ], and disseminated cancer [ 40 ]. However, only an independent external validation study of 2 predictive models in patients with LACC performed in different population was published [ 24 ].…”

Results from Survey to Assess Current Trends in Surgical Practice in the Management of Women with Early Stage Cervical Cancer within the BGCS Community with an Emphasis on Routine Frozen Section Examination

“…Introducing universally accepted standardised FSE protocols and ensuring reporting by specialist pathologists have been shown to improve FSE accuracy [ 15 ]. Provided that FSE accuracy is satisfactory, identification of patients at low risk for nodal metastases may theoretically help inform selected patients in the absence of enlarged lymph nodes or SLNs towards less aggressive surgical interventions and reduce the lymphadenectomy-related morbidity [ 16 ]. Implementation of FSE with ultrastaging may prove cost-effective in high risk patients with respect to avoiding morbidity and should be explored.…”