Development and validation of a prognostic nomogram for 2018 FIGO stages IB1, IB2, and IIA1 cervical cancer: a large multicenter study.

Autor:	Chen X; Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China., Duan H; Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China., Liu P; Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China., Lin L; Department of Gynecology, Anyang Cancer Hospital, Anyang, China., Ni Y; Department of Obstetrics and Gynecology, Yuncheng Central Hospital, Yuncheng, China., Li D; Department of Obstetrics and Gynecology, Guizhou Provincial People's Hospital, Guizhou, China., Dai E; Department of Obstetrics and Gynecology, Linyi People's Hospital, Linyi, China., Zhan X; Department of Gynecology, Jiangmen Central Hospital, Jiangmen, China., Li P; Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China., Huo Z; Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China., Bin X; Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou, China., Lang J; Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China., Chen C; Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Jazyk:	angličtina
Zdroj:	Annals of translational medicine [Ann Transl Med] 2022 Jan; Vol. 10 (2), pp. 121.
DOI:	10.21037/atm-21-6367
Abstrakt:	Background: Nomograms are predictive tools widely used for estimating cancer prognosis. We aimed to develop/validate a nomogram to predict the postsurgical 5-year overall survival (OS) and disease-free survival (DFS) probability for patients with stages IB1, IB2, and IIA1 cervical cancer [2018 International Federation of Gynecology and Obstetrics (FIGO 2018)]. Methods: We retrospectively enrolled cervical cancer patients at 47 hospitals with stages IB1, IB2, and IIA1 disease from the Clinical Diagnosis and Treatment for Cervical Cancer in China database. All patients were assigned to either the development or validation cohort (75% of patients used for model construction and 25% used for validation). OS and DFS were defined as the clinical endpoints. Clinicopathological variables were analyzed based on the Cox proportional hazards regression model. A nomogram was established and validated internally (with bootstrapping) and externally, and its performance was assessed according to the concordance index (C-index), receiver-operating characteristic curve, and calibration plot. Results: In total, 4,065 patients were enrolled and assigned to the development cohort (n=3,074) or validation cohort (n=991). The OS nomogram was constructed based on age, FIGO stage, stromal invasion, and lymphovascular space invasion (LVSI). The DFS nomogram was constructed based on the FIGO stage, histological type, stromal invasion, and LVSI. Both nomograms showed greater discrimination than the FIGO 2018 staging system in the development cohort [OS nomogram vs. FIGO 2018: C-index =0.69 vs. 0.61, area under the curve (AUC): 69.8 vs. 60.3; DFS nomogram vs. FIGO 2018: C-index =0.64 vs. 0.57, AUC: 62.6 vs. 56.9], and the same results were observed the definition in the validation cohort. Calibration plots demonstrated good agreement between the predicted and actual probabilities of 5-year OS/DFS in the development and validation cohorts. We stratified the patients into 3 subgroups with differences in OS/DFS. Each risk subgroup presented a distinct prognosis. Conclusions: We successfully developed a robust and powerful model for predicting 5-year OS/DFS in stages IB1, IB2, and IIA1 cervical cancer (FIGO 2018) for the first time. Internal and external validation showed that the model had great prediction performance and was superior to the currently utilized FIGO staging system. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-21-6367/coif). The series “New Progress and Challenge in Gynecological Cancer” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare. (2022 Annals of Translational Medicine. All rights reserved.)
Databáze:	MEDLINE
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