J Gynecol Oncol.  2017 Sep;28(5):e58. 10.3802/jgo.2017.28.e58.

Prognostic models for locally advanced cervical cancer: external validation of the published models

• Lora D
• Gómez de la Cámara A
• Fernández SP
• Enríquez de Salamanca R
• Gómez JF

• KMID: 2413219
• DOI: http://doi.org/10.3802/jgo.2017.28.e58

Abstract

OBJECTIVE
To externally validate the prognostic models for predicting the time-dependent outcome in patients with locally advanced cervical cancer (LACC) who were treated with concurrent chemoradiotherapy in an independent cohort.
METHODS
A historical cohort of 297 women with LACC who were treated with radical concurrent chemoradiotherapy from 1999 to 2014 at the 12 de Octubre University Hospital (H12O), Madrid, Spain. The external validity of prognostic models was quantified regarding discrimination, calibration, measures of overall performance, and decision curve analyses.
RESULTS
The review identified 8 studies containing 13 prognostic models. Different (International Federation of Gynecology and Obstetrics [FIGO] stages, parametrium involvement, hydronephrosis, location of positive nodes, and race) but related cohorts with validation cohort (5-year overall survival [OS]=70%; 5-year disease-free survival [DFS]=64%; average age of 50; and over 79% squamous cell) were evaluated. The following models exhibited good external validity in terms of discrimination and calibration but limited clinical utility: the OS model at 3 year from Kidd et al.'s study (area under the receiver operating characteristic curve [AUROC]=0.69; threshold of clinical utility [TCU] between 36% and 50%), the models of DFS at 1 year from Kidd et al.'s study (AUROC=0.64; TCU between 24% and 32%) and 2 years from Rose et al.'s study (AUROC=0.70; TCU between 19% and 58%) and the distant recurrence model at 5 years from Kang et al.'s study (AUROC=0.67; TCU between 12% and 36%).
CONCLUSION
The external validation revealed the statistical and clinical usefulness of 4 prognostic models published in the literature.

Keyword

Uterine Cervical Neoplasms; Chemoradiotherapy; Prognosis; Proportional Hazards Models; Validation Studies

MeSH Terms

Adult
Aged
Aged, 80 and over
Area Under Curve
Chemoradiotherapy
Cohort Studies
Disease-Free Survival
Female
Humans
Middle Aged
Neoplasm Recurrence, Local/epidemiology
Prognosis
Proportional Hazards Models
ROC Curve
Risk
Spain
Treatment Outcome
Uterine Cervical Neoplasms/*diagnosis/*mortality/therapy