Score for the Overall Survival Probability of Patients With First-Diagnosed Distantly Metastatic Cervical Cancer: A Novel Nomogram-Based Risk Assessment System.

Shilong Zhang,Wenrong Wang,Xin Wang,Lishun Wang,Zhanming Li

doi:10.3389/fonc.2019.01106

Abstract

Background: Metastatic cervical cancer (mCEC) is the end stage of cervical cancer. This study aimed to establish and validate a nomogram to predict the overall survival (OS) of mCEC patients.Methods: We investigated the Surveillance, Epidemiology, and End Results (SEER) database for mCEC patients diagnosed between 2010 and 2014. Univariate and multivariable Cox analyses was performed to select the clinically important predictors of OS when developing the nomogram. The performance of nomogram was validated with Harrell's concordance index (C-index), calibration curves, receiver operating characteristic curve (ROC), and decision curve analysis (DCA).Results: One thousand two hundred and fifty-two mCEC patients were included and were divided into training (n = 880) and independent validation (n = 372) cohorts. Age, race, pathological type, histology grade, radiotherapy, and chemotherapy were independent predictors of OS and used to develop the nomogram for predicting 1- and 3-year OS. This nomogram had a C-index of 0.753 (95% confidence interval [CI]: 0.780–0.726) and 0.751 (95% CI: 0.794–0.708) in the training and the validation cohorts, respectively. Internal and external calibration curves indicated satisfactory agreement between nomogram prediction and actual survival, and DCA indicated its clinical usefulness. Furthermore, a risk stratification system was established that was able to accurately stratify mCEC patients into three risk subgroups with significantly different prognosis.Conclusions: We constructed the first nomogram and corresponding risk classification system to predict the OS of mCEC patients. These tools showed satisfactory accuracy, and clinical utility, and could aid in patient counseling and individualized clinical decision-making.

Highlights

Worldwide, cervical cancer is the third most common malignant tumor and the fourth leading cause of cancer-related mortality in the female population [1]
About 30% of cervical cancer patients present with distant metastasis at initial diagnosis, especially in developing countries [2]
The survival for metastatic cervical cancer (mCEC) is influenced by multiple factors, including age, pathological type, metastasis pattern, and treatment strategy [5, 6]

Summary

Introduction

Cervical cancer is the third most common malignant tumor and the fourth leading cause of cancer-related mortality in the female population [1]. About 30% of cervical cancer patients present with distant metastasis at initial diagnosis, especially in developing countries [2]. Despite considerable advances in the treatment, patients with distant metastasis suffer dismal prognosis, with a median survival of 8–13 months [3]. Metastatic cervical cancer (mCEC) is a heterogeneous disease and varies substantially in prognosis [4]. The survival for mCEC is influenced by multiple factors, including age, pathological type, metastasis pattern, and treatment strategy [5, 6]. An accurate prediction of survival may benefit mCEC patients and professional doctors alike in all aspects of clinical decision-making, and render individualized treatment and surveillance possible. Metastatic cervical cancer (mCEC) is the end stage of cervical cancer. This study aimed to establish and validate a nomogram to predict the overall survival (OS) of mCEC patients

Objectives

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Conclusion