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. 2021 Dec 29:13:9391-9400.
doi: 10.2147/CMAR.S336892. eCollection 2021.

Nomogram Predicting Overall Survival in Patients with FIGO II to III Squamous Cell Cervical Carcinoma Under Radical Radiotherapy: A Retrospective Analysis Based on 2018 FIGO Staging

Lele Zang  1 , Qin Chen  1 , Xiaozhen Zhang  2 , Xiaohong Zhong  3 , Jian Chen  1 , Yi Fang  1 , An Lin  1 , Min Wang  1
Affiliations

Nomogram Predicting Overall Survival in Patients with FIGO II to III Squamous Cell Cervical Carcinoma Under Radical Radiotherapy: A Retrospective Analysis Based on 2018 FIGO Staging

Lele Zang et al. Cancer Manag Res. .

Abstract

Purpose: To present a nomogram to predict overall survival in patients with FIGO-2018 II to III squamous cell cervical carcinoma undergoing radical radiotherapy.

Patients and methods: Patients diagnosed with FIGO-2018 II to III squamous cell cervical cancer between December 2013 and December 2014 were analyzed retrospectively. The optimal cutoff point for tumor length and width were determined by R package. We identified prognostic factors by univariate and multivariate Cox proportional-hazard regression, then built a nomogram to visualize the prediction model. Our model was compared to the 2018 FIGO staging prediction model. Harrell's concordance index, receiver operating characteristic curve, calibration plot were used to evaluate the discriminability and accuracy of the predictive models, and decision curve analysis (DCA) was used to show the net benefits.

Results: Data from 469 patients were included in the final analyses. The cutoff values of tumor length and width were 5.10 cm and 4.13 cm, respectively. Four independent prognostic variables-tumor length, tumor width, lower one-third vaginal involvement, and lymph node metastases-were used to establish the nomogram. The C-index of the nomogram was 0.71 (95%, CI = 0.66-0.77), which was better than that of the 2018 FIGO stage prediction model (C-index: 0.62, 95% CI = 0.58-0.66, p = 0.009). The calibration plot of the nomogram was a good fit for both 3-year and 5-year overall survival predictions. And DCA curves showed that net benefits for our model were higher than FIGO-2018 staging system.

Conclusion: A clinically useful nomogram for calculating overall survival probability in FIGO-2018 II to III squamous cell cervical cancer patients who had received radical radiotherapy was developed. Tumor length, tumor width, lower one-third vaginal involvement, and lymph node metastases were found to be independent prognostic factors. Our model performed better than the 2018 FIGO staging model. The findings could help clinicians in China to predict the survival of these patients in clinical care and research.

Keywords: cervical carcinoma; nomogram; overall survival; radiotherapy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the patients’ enrollment and exclusion.
Figure 2
Figure 2
The cut-off values of tumor length and width. (A) Tumor length; (B) tumor width.
Figure 3
Figure 3
Nomogram for predicting the overall survival probability in cervical cancer patients whose FIGO-2018 stage were II and III.
Figure 4
Figure 4
Internal calibration of nomogram of 3-year and 5-year survival. (A) Internal calibration of nomogram of 3-year overall survival; (B) internal calibration of nomogram of 5-year overall survival.
Figure 5
Figure 5
Decision curve analysis (DCA) for 3- and 5-year OS. (A) DCA curve of nomogram and FIGO-2018 staging system of 3-year overall survival; (B) DCA curve of nomogram and FIGO-2018 staging system of 5-year overall survival.
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