Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;12(24):21798-21806.
doi: 10.1002/cam4.6745. Epub 2023 Nov 23.

A novel nomogram and risk stratification for early metastasis in cervical cancer after radical radiotherapy

Linying Liu  1 , Jie Lin  1 , Sufang Deng  1 , Haijuan Yu  1 , Ning Xie  1 , Yang Sun  1
Affiliations

A novel nomogram and risk stratification for early metastasis in cervical cancer after radical radiotherapy

Linying Liu et al. Cancer Med. 2023 Dec.

Abstract

Object: This study aimed to establish an effective risk nomogram to predict the early distant metastasis (EDM) probability of cervical cancer (CC) patients treated with radical radiotherapy to aid individualized clinical decision-making.

Methods: A total of 489 patients with biopsy-confirmed CC between December 2018 and January 2021 were enrolled. Logistic regression with the stepwise backward method was used to identify independent risk factors. The nomogram efficacy was evaluated by using the area under the receiver operating characteristic curve (AUC), C-index by 1000 bootstrap replications, etc. Finally, patients were divided into high- and low-risk groups of EDM based on the cut-off value of nomogram points.

Results: 36 (7.36%) CC patients had EDM, and 20 (55.6%) EDM had more than one metastatic site involved. Age below 51 (OR = 2.298, p < 0.001), tumor size larger than 4.5 cm (OR = 3.817, p < 0.001) and radiotherapy (OR = 3.319, p < 0.001) were independent risk factors of EDM. For the nomogram model, C-index was 0.701 (95% CI = 0.604-0.798), and 0.675 (95% CI = 0.578-0.760) after 1000 bootstrap resampling validations. The Hosmer-Lemeshow test demonstrated no overfitting (p = 0.924). According to the Kaplan-Meier curve of risk score, patients with high risk were more prone to get EDM (p < 0.001).

Conclusion: This is the first research to focus on EDM in CC patients. We have developed a robust scoring system to predict the risk of EDM in CC patients to screen out appropriate cases for consolidation therapy and more intensive follow-up.

Keywords: cervical cancer; early distant metastasis; prognostic model; radiotherapy; risk factors.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

FIGURE 1
FIGURE 1
Flowchart of patient eligibility screening.
FIGURE 2
FIGURE 2
Nomogram (A) and Receiver operating characteristic (ROC) curve (B) for predicting the probability of EDM.
FIGURE 3
FIGURE 3
Calibration plots (A) and DCA (B) of the nomogram predicting EDM.
FIGURE 4
FIGURE 4
Kaplan–Meier analysis in high‐and low‐ risk groups.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191‐e203. - PMC - PubMed
    1. Mayadev JS, Ke G, Mahantshetty U, Pereira MD, Tarnawski R, Toita T. Global challenges of radiotherapy for the treatment of locally advanced cervical cancer. Int J Gynecol Cancer. 2022;32(3):436‐445. - PMC - PubMed
    1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209‐249. - PubMed
    1. Liu YJ, Keane A, Simms KT, et al. Development and application of a framework to estimate health care costs in China: the cervical cancer example. PloS One. 2019;14(10):e0222760. - PMC - PubMed
    1. Okazawa‐Sakai M, Mabuchi S, Isohashi F, et al. Predictors of distant relapse in patients with FIGO stage IIB‐IVA cervical cancer treated with definitive radiotherapy. J Obstet Gynaecol Res. 2017;43(11):1743‐1750. - PubMed

Publication types