Predicting lymphovascular space invasion in early-stage cervical squamous cell carcinoma using heart rate variability

Abstract

Background: Accurate preoperative assessment of lymphovascular space invasion (LVSI) in patients with early-stage cervical squamous cell carcinoma (ECSCC) is clinically significant for guiding treatment decisions and predicting prognosis. However, current LVSI assessment of ECSCC mainly relies on the invasive method of pathological biopsy, which needs to be further improved in terms of convenience. The main objective of this study is to verify the value of preoperative heart rate variability (HRV) parameters in predicting ECSCC LVSI.

Methods: A total of 79 patients with ECSCC confirmed by postoperative pathology were enrolled in this study at the Department of Gynecologic Oncology of the First Affiliated Hospital of Bengbu Medical University. Patients were classified as LVSI-positive (LVSI+) or LVSI-negative (LVSI-) based on pathological examination. Preoperative 5-minute electrocardiogram (ECG) data were collected from all patients, and their HRV parameters were analysed, including 7 time-domain parameters, 5 frequency-domain parameters, and 2 nonlinear parameters. Ten HRV features were selected through univariate analysis, and a logistic model was constructed using age, body mass index, menopausal status, and mean heart rate to predict LVSI status. The model performance was evaluated by the area under the receiver operating characteristic curve (AUC), accuracy, precision, sensitivity, and specificity.

Results: The constructed model showed good predictive performance, with an AUC of 0.845 (95% CI: 0.761 - 0.930), sensitivity of 0.871, specificity of 0.750, precision of 0.690, and accuracy of 0.747.

Conclusions: The Logistic model constructed based on HRV features has a relatively good diagnostic performance in predicting the LVSI status of ECSCC, but further research is still needed through larger datasets, more features, and the combination of machine learning models.

Keywords: autonomic nervous system; cervical cancer; cervical squamous cell carcinoma; heart rate variability; lymphovascular space invasion.

Figure 1

H&E stained images of LVSI negative and positive sections in early cervical squamous cell carcinoma tissues (×400 magnification, representative areas selected from postoperative pathological specimens). (A) LVSI-negative section, no tumor cell infiltration of lymphovascular spaces was observed. (B) LVSI-positive section, arrows indicate tumor cell infiltration of LVSI, presenting as tumor cell clusters located within the lumen of vascular endothelium.

Figure 2

ROC curves for Model 1 and Model 2.