Cancer Res Treat.  2018 Jul;50(3):768-776. 10.4143/crt.2017.141.

Survival Nomograms after Curative Neoadjuvant Chemotherapy and Radical Surgery for Stage IB2-IIIB Cervical Cancer

• Marchetti
• De Felice
• Di Pinto A
• Romito A
• Musella A
• Palaia I
• Monti M
• Tombolin V
• Muzii L
• Benedetti Panici P

• KMID: 2417866
• DOI: http://doi.org/10.4143/crt.2017.141

Abstract

PURPOSE
The purpose of this study was to develop nomograms for predicting the probability of overall survival (OS) and progression-free survival (PFS) in locally advanced cervical cancer treated with neoadjuvant chemotherapy and radical surgery.
MATERIALS AND METHODS
Nomograms to predict the 5-year OS rates and the 2-year PFS rates were constructed. Calibration plots were constructed, and concordance indices were calculated. Evaluated variableswere body mass index, age, tumor size, tumor histology, grading, lymphovascular space invasion, positive parametria, and positive lymph nodes.
RESULTS
In total 245 patients with locally advanced cervical cancer who underwent neoadjuvant chemotherapy and radical surgery were included for the construction of the nomogram. The 5-year OS and PFS were 72.6% and 66%, respectively. Tumor size, grading, and parametria status affected the rate of OS, whereas tumor size and positive parametria were the main independent PFS prognostic factors.
CONCLUSION
We constructed a nomogram based on clinicopathological features in order to predict 2-year PFS and 5-year OS in locally advanced cervical cancer primarily treated with neoadjuvant chemotherapy followed by radical surgery. This tool might be particularly helpful for assisting in the follow-up of cervical cancer patients who have not undergone concurrent chemoradiotherapy.

Keyword

Nomograms; Locally advanced disease; Uterine cervical neoplasms; Neoadjuvant chemotherapy; Radical surgery; Clinical outcomes; Survival; Recurrence

MeSH Terms

Body Mass Index
Calibration
Chemoradiotherapy
Disease-Free Survival
Drug Therapy*
Follow-Up Studies
Humans
Lymph Nodes
Nomograms*
Recurrence
Uterine Cervical Neoplasms*

Figure

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  Fig. 1. Overall survival according to International Federation of Gynecology and Obstetrics stage.

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  Fig. 2. Disease-free survival for the entire study population.

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  Fig. 3. Five-year overall survival nomogram. BMI_25 indicates body mass index ≥ 25 (1) or < 25 (0). Age_50 indicates age ≥ 50 (1) or < 50 (0) at diagnosis. Tsize_4 indicates clinical tumor size ≥ 4 (1) or < 4 (0). Squamous indicates squamous cell carcinoma (1) or other tumor histologies (2). LVSI indicates presence (1) or absence (0) of lymphovascular space invasion. Positive_lymph_nodes indicates pathological positive (1) or negative (0) locoregional lymph nodes. Positive_parametria indicates pathological positive (1) or negative (0) parametria. To use, find patient’s BMI on BMI_25 axis, then draw straight line upward to points axis to determine how many points patient receives for BMI. Do this again for other axes, each time drawing straight line upward toward points axis. Sum points received for each variable, and find sum on total points axis. Draw straight line down to survival-probability axis to find patient’s probability of 5-year OS. BMI, body mass index; FIGO, International Federation of Gynecology and Obstetrics; OS, overall survival.

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  Fig. 4. Two-year progression-free survival nomogram. BMI_25 indicates body mass index ≥ 25 (1) or < 25 (0). Age_50 indicates age ≥ 50 (1) or < 50 (0) at diagnosis. Tsize_4 indicates clinical tumor size ≥ 4 (1) or < 4 (0). Squamous indicates squamous cell carcinoma (1) or other tumor histologies (2). LVSI indicates presence (1) or absence (0) of lymphovascular space invasion. Positive_lymph_nodes indicates pathological positive (1) or negative (0) locoregional lymph nodes. Positive_parametria indicates pathological positive (1) or negative (0) parametria. To use, find patient’s BMI on BMI_25 axis, then draw straight line upward to points axis to determine how many points patient receives for BMI. Do this again for other axes, each time drawing straight line upward toward points axis. Sum points received for each variable, and find sum on total points axis. Draw straight line down to survival-probability axis to find patient’s probability of 2-year PFS. BMI, body mass index; FIGO, International Federation of Gynecology and Obstetrics; PFS, progression-free survival.

Reference

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