Prognostic Nomograms Predicting Survival in Patients With Locally Advanced Cervical Squamous Cell Carcinoma: The First Nomogram Compared With Revised FIGO 2018 Staging System.

Xi Yang,Lingying Wu,Yuanyuan Zhang,Manni Huang,Jusheng An,Siye Chen,Yong Yang

doi:10.3389/fonc.2020.591700

Abstract

ObjectivesTo develop nomograms to assess prognostic factors for 5-year overall survival (OS) and 5-year progression-free survival (PFS) in locally advanced cervical squamous cell carcinoma (LACSC).MethodsOverall, 618 patients with LACSC were included in this retrospective analysis. Nomograms for 5-year OS and PFS were developed based on Cox proportional hazards regression models. Concordance index (C-index) and calibration curves were used to define the predictive and discriminatory capacity of the nomogram. A comparison between the nomogram and the International Federation of Gynecology and Obstetrics (FIGO) staging system was conducted using time-dependent receiver operating characteristic (tROC) and area under the curve (tAUC).ResultsMultivariate analysis identified several prognostic factors for OS including squamous cell carcinoma antigen (SCC-Ag), body mass index (BMI), tumor size, pelvic wall involvement, and para-aortic lymph node metastasis (PALNM). Prognostic factors for PFS included BMI, hemoglobin (HGB), tumor size, pelvic wall involvement, pelvic lymph node metastasis (PLNM) and PALNM. Following bootstrap correction, the C-index of OS and PFS was 0.713 and 0.686, respectively. These nomograms showed superior performance compared with the FIGO 2009 and 2018 staging schema.ConclusionsNomograms were developed to identify prognostic factors for 5-year OS and PFS in patients with LACSC. These nomograms showed good prognostication and are more comprehensive in predicting survival outcomes than existing staging criteria.

Highlights

Cervical cancer is the fourth most common cancer in females, with around 570,000 new cases of cervical cancer diagnosed per year worldwide, leading to ~300,000 deaths every year [1,2,3]
Pelvic lymph nodes were involved in 52.2% of patients, and paraaortic lymph node metastasis (PALNM) was observed in 5.7% of patients
The majority of patients had stage IIB and IIIB disease according to the Federation of Gynecology and Obstetrics (FIGO) 2009 staging system (n = 324, 52.8% and n = 232, 37.8%, respectively), or IIB and IIIC1r disease based on FIGO 2018 criteria (n = 193, 31.5% and n = 282, 46%, respectively)

Summary

Introduction

Cervical cancer is the fourth most common cancer in females, with around 570,000 new cases of cervical cancer diagnosed per year worldwide, leading to ~300,000 deaths every year [1,2,3]. In 2015, a total of 98.9 thousand new cases and 30.5 thousand deaths from cervical cancer were reported in China [4]. Concurrent chemoradiotherapy (CCRT) is the standard treatment for patients with locally advanced cervical cancer (LACC). Multiple clinical trials of investigational therapies have been conducted. The inclusion criteria of most clinical trials are based on the staging system of the International Federation of Gynecology and Obstetrics (FIGO). The FIGO 2009 system is gynecologic examination-based and does not cover lymph node status. With a concordance index (C-index) < 0.6, it is not accurate enough for predicting survival [5, 6]

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