Validation of Nomograms for Survival and Metastases after Hysterectomy and Adjuvant Therapy in Uterine Cervical Cancer with Risk Factors

Abstract

Background. Three nomogram models for early stage uterine cervical cancer have been developed (KROG 13-03 for overall survival [OS], SNUH/AMC for disease-free survival [DFS], and KROG 12-08 for distant metastases-free survival [DMFS]) after radical hysterectomy (RH) and pelvic lymph node dissection (PLND). This study aimed to validate these models using our cohort with adjuvant radiotherapy. Methods. According to the eligibility criteria of nomogram studies, patients were enrolled in Group A (N = 109) for the two KROG models (RH with PLND and whole pelvic irradiation) and Group B (N = 101) for the SNUH/AMC model (RH with PLND and squamous histology). Using Cox-regression hazard models, the prognostic factors of our cohorts were evaluated. The risk probabilities induced from published nomogram scores were calculated and the concordance indices were evaluated. Results. Group A had 88.1% 5-year OS and 86.0% 5-year DMFS. Group B had 83.0% 5-year DFS. In multivariate analyses, large tumor size for OS (HR 8.62, P < 0.001) and DMFS (HR 5.13, P = 0.003), young age (≤40 versus 41–64 years) for OS (HR 4.63, P = 0.097) and DFS (HR 3.44, P = 0.051), and multiple lymph node metastases (0 versus ≥3) for DMFS (HR 4.03, P = 0.031) and DFS (HR 3.90, P = 0.038) were significantly correlated. The concordance indices for OS, DMFS, and DFS were 0.612 (P = 0.002), 0.597 (P = 0.014), and 0.587 (P = 0.020), respectively. Conclusion. The developed nomogram models after RH and PLND are clinically useful in predicting various types of survival with significance.

A Novel Diagnostic Nomogram for Noninvasive Evaluating Liver Fibrosis in Patients with Chronic Hepatitis B Virus Infection

“…Nomograms from multivariable logistic models are used as a graphical user interface to display the predicted probabilities of an event [19]. Nomograms are frequently used to estimate prognosis in oncology [20][21][22][23][24][25][26][27][28][29][30][31][32]. Gao et al developed a prognostic nomogram to assess the individual prognosis for CHB patients.…”

Patterns of recurrence and prognosis in locally advanced FIGO stage IB2 to IIB cervical cancer: Retrospective multicentre study from the FRANCOGYN group

“…To reduce this heterogeneity, several epidemiological, histological and treatment prognostic factors for recurrence and survival have been reported and are currently used to define optimal CC management [12] [13]. In this setting, different models have been developed based on the prognostic factors to predict recurrence and survival in LACC [6] [14][15] [16]. However, to date, few evidence-based data are available about patterns of recurrence (location, timing from initial treatment) and prognosis for FIGO stage IB2 to IIB CC.…”

Prediction Models for Prognosis of Cervical Cancer: Systematic Review and Critical Appraisal

“…A prognostic model is a formal combination, usually a statistical equation, of multiple predictors, from which risks of a specific outcome can be calculated for individuals (15)(16)(17). As for cervical cancer patients, due to the limited predictive value for the classification of the International Federation of Gynecology and Obstetrics (FIGO) alone, a couple of prognostic models have been proposed to predict and guide treatments based on different tumor and demographic characteristics (13,18). However, the uneven quality and the diversity of the clinical settings, outcomes, and predictors may limit the practicality of models, and systematic reviews on prognostic models of other diseases also suggested that the methodological features of existing studies varied (19)(20)(21).…”