Prognostic Significance of Nomogram and T-Score in Locally Advanced Cervical Cancer Patients Treated with Curative Chemoradiotherapy and Image-Guided Brachytherapy: A Single-Center Retrospective Study

Abstract

Objective: To investigate the survival prediction probability of the nomogram from retro-EMBRACE and the T-score in patients with locally advanced cervical cancer (LACC). Materials and Methods: A total of 204 patients with LACC who underwent curative chemoradiotherapy and brachytherapy (BT) between 2010 and 2021 were included in our single-center retrospective study. Clinical records, examinations, and magnetic resonance images (MRI) before and after external beam radiotherapy (EBRT) were retrospectively reviewed to obtain information on age, tumor size, parametrial involvement, ureteral involvement, bladder invasion, uterine involvement, high-risk clinical target volume at the first brachytherapy application, lymph node involvement, vaginal involvement, recurrence, metastasis, and last follow-up. The 5-year overall survival probabilities of the patients were determined by nomogram. T-score was calculated separately at diagnosis (TS_D) and brachytherapy (TS_BT), and their effects on local recurrence-free survival, disease-free survival, and overall survival were analyzed. Results: The median age was 52 (29-89). The 5-year survival rate of the patients was calculated to be 90.18%. The median nomogram's survival estimate for 60 months was 70.35% (20.9-87.1). The median TS_D and TS_BT were 5.5 (1-16) and 1 (0-6), respectively. According to the multivariate Cox regression models, TS_D (HR = 1.203, 95% CI 1.021-1.417, p = 0.024) was significantly associated with local recurrence-free survival. Conclusions: This study demonstrated that the nomogram's predictions for 60-month overall survival are underestimates. Prognosis can be estimated using the TS_D, which can be easily obtained with a clinical examination and detailed MRI examination.

Keywords: brachytherapy; cervical cancer; local recurrence; overall survival; radiotherapy.

Figure 1

Schematic diagram of the study design.

Figure 2

Box plots for TS_D and TS_BT according to the FIGO T stages. (FIGO: The International Federation of Gynecology and Obstetrics; TS_D: pre-treatment T-score at diagnosis; TS_BT: pre-treatment T-score at brachytherapy.)

Figure 3

Survival according to pre-treatment T-score at diagnosis (TS_D) groups: (a) local recurrence-free survival; (b) disease-free survival; and (c) overall survival.

Figure 4

Survival according to regression pattern groups: (a) local recurrence-free survival; (b) disease-free survival; and (c) overall survival; L: Low–Low, HL: High–Low, HH: High–High.