Postoperative nomogram for the prediction of disease-free survival in lymph node-negative stage I–IIA cervical cancer patients treated with radical hysterectomy

Abstract

The purpose of this study was to develop and validate a nomogram for individual prediction of recurrence and disease-free survival (DFS) among lymph node (LN)-negative early-stage (I–IIA) cervical cancer (CC) patients treated with Type B or Type C2 hysterectomy. Data were collected from patients diagnosed with CC between 1995 and 2017 at the Gynecological Oncology Department, Tepecik Training and Research Hospital. A total of 194 cases with stage IA2–IIA CC were evaluated retrospectively. Patients with stage IA2–IIA CC who underwent radical (Type C2) or modified radical (Type B) hysterectomy and pelvic ± paraaortic LN dissection with LN negativity were included in the study. The relationships between prognostic factors such as stage, tumour size, parametrial involvement, vaginal cuff margin, endomyometrial infiltration, and lymphovascular space invasion status and DFS were compared using a univariable Cox regression model. When the nomogram was prepared, the scores of the risk factors were collected, and we observed that scores were at least 0 to a maximum of 414 points. The concordance-index for the nomogram was 0.895 (95% confidence interval, 0.79–0.99). The nomogram based on the indicated prognostic factors yielded excellent results in predicting recurrence in early-stage CC patients without LN metastasis who underwent radical hysterectomy.Impact statementWhat is already known on this subject? Pathology of radical hysterectomy specimens in patients with early-stage cervical cancer provides information that has predictive prognostic potential. In addition to FIGO stage, other important prognostic factors are lymph node status, tumour size, parametrial involvement, vaginal cuff margin status, endomyometrial infiltration, histological type, patient age, lymphovascular space invasion, histological grade, and depth of cervical stromal invasion.What do the results of this study add? In this study, patients with early-stage cervical cancer who underwent radical and modified radical hysterectomy without retroperitoneal lymph node involvement were evaluated, and recurrence development and factors affecting disease-free survival were investigated. A nomogram consisting of factors influencing disease-free survival was constructed. The total score was determined according to the status of all risk factors. This allowed clear definition of the risk for each patient. A nomogram predicting recurrence in patients with stages IA2–IIA cervical cancer with radical hysterectomy without lymph node involvement has not previously been published.What are the implications of these findings for clinical practice and/or further research? Our study investigated early-stage cervical cancer (CC) patients without lymph node (LN) metastasis. Cox regression analysis was performed with six prognostic factors: FIGO stage, tumour size, parametrial margin infiltration, vaginal cuff margin involvement, endomyometrial infiltration, and LVSI positivity. The nomogram was constructed based on the results of Cox regression. The C-index for the nomogram was 0.895 (95% CI, 0.79–0.99). These results can be considered excellent. The higher concordance index in our study indicates that these six factors may be more valuable in predicting recurrence development in CC patients.