Factors related to postoperative adjuvant therapy of locally advanced cervical cancer and building of a nomogram prediction model

doi:10.3760/cma.j.cn371439-20200527-00006

Abstract

Abstract:

Objective To explore the related factors of postoperative adjuvant therapy for cervical cancer stagedⅠB1-ⅡA2 [according to 2018 International Federation of Gynecology and Obstetrics (FIGO) staging standard], and to establish a nomogram model to predict the risk of postoperative adjuvant therapy for locally advanced cervical cancer. Methods A total of 714 patients with cervical squamous cell cancer staged FIGO ⅠB1-ⅡA2 treated by surgery in Anhui Provincial Hospital were selected as the research objects from January 2009 to December 2019, and their clinicopathological data were analyzed. Multiple logistic regression analysis was used to determine the influencing factors, and a nomogram model was established to predict the risk of postoperative adjuvant treatment of cervical cancer. The predictive performance of the model was evaluated with the consistency index (C-index), and the compliance of the model was evaluated with the calibration curve. Results Univariate analysis suggested that postoperative adjuvant therapy for cervical cancer was associated with gravidity (χ²=11.506, P=0.001), underlying disease (hypertension or diabetes) (χ²=7.668, P=0.006), squamous cell cancer antigen (SCC-AG) level (χ²=19.392, P<0.001), imaging risk factors (χ²=16.392, P<0.001), FIGO stage (χ²=25.686, P<0.001), tumor size (χ²=9.392, P=0.025) and surgical path (χ²=16.590, P<0.001). Multivariate logistic regression analysis suggested that the number of pregnancy >2 times (OR=1.951, 95%CI: 1.355-2.808, P<0.001), SCC-Ag ≥1.5 μg/L (OR=2.021, 95%CI: 1.444-2.829, P<0.001), FIGO stage ⅠB3-ⅡA2 [ⅠB3 (OR=1.933, 95%CI: 1.139-3.282, P=0.015); ⅡA1 (OR=2.723, 95%CI: 1.556-4.765, P<0.001); ⅡA2 (OR=3.159, 95%CI: 1.502-6.646, P=0.002)], with underlying disease (hypertension or diabetes) (OR=1.867, 95%CI: 1.051-3.318, P=0.033), imaging risk factors (OR=1.997, 95%CI: 1.127-3.537, P=0.018), without neoadjuvant therapy [preoperative neoadjuvant therapy for 1 cycle (OR=0.402, 95%CI: 0.207-0.783, P=0.007)] and laparoscopic surgery (OR=2.177, 95%CI: 1.524-3.112, P<0.001) were independent influencing factors for postoperative adjuvant treatment of cervical cancer. Based on the screened variables, the nomogram model to predict the risk of postoperative adjuvant treatment for cervical cancer has good predictive performance (C-index was 0.702) and compliance. Conclusion The number of pregnancy >2 times, SCC-Ag ≥1.5 μg/L, FIGO stage ⅠB3-ⅡA2, with underlying disease (hypertension or diabetes), imaging risk factors, without neoadjuvant therapy, and laparoscopic surgery are independent influencing factors for postoperative adjuvant treatment of cervical cancer. A nomogram model has been constructed to predict the risk of postoperative adjuvant therapy for locally advanced cerrical cancer, and it can provide evidence for clinical treatment selection.

Key words: Uterine cervical neoplasms, Nomograms, Influencing factors

Yu Mingyue, Chen Zhengzheng, Zhao Xuxu, Ren Pingping, Zhang Ying, Ge Li, Zhu Meiling, Zhao Weidong. Factors related to postoperative adjuvant therapy of locally advanced cervical cancer and building of a nomogram prediction model[J]. Journal of International Oncology, 2021, 48(1): 35-40.

Figures/Tables 4

References 23

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因素	未辅助治疗组 (n=441)	辅助治疗组 (n=273)		χ²值	P值
年龄(岁)
≤35	39	24	0.001		0.981
>35	402	249
初潮年龄(岁)^a
<14	91	59	0.229		0.632
≥14	306	181
因素	未辅助治疗组 (n=441)	辅助治疗组 (n=273)		χ²值		P值
孕次
≤2次	162	67	11.506			0.001
>2次	279	206
产次
≤2次	342	195	3.390			0.066
>2次	99	78
是否合并基础疾病 (高血压或糖尿病)
是	26	32	7.668			0.006
否	415	241
SCC-Ag(μg/L)
<1.5	246	106	19.392			<0.001
≥1.5	195	167
血红蛋白(g/L)
<110	112	64	0.346			0.556
≥110	329	209
影像学检查是否伴有危险因素
有	24	39	16.392			<0.001
无	417	234
FIGO分期
ⅠB1	121	50
ⅠB2	180	89
ⅠB3	73	55	25.686			<0.001
ⅡA1	43	50
ⅡA2	24	29
肿瘤大小(cm)
<2	128	58
≥2且<4	216	131	9.392			0.025
≥4且<5	65	53
≥5	32	31
组织学分化程度
高分化(G1)	14	9
中分化(G2)	283	178	0.105			0.949
低分化(G3)	144	86
术前新辅助化疗的疗程数
0	387	247
1	40	19	1.263			0.532
2	14	7
手术路径
开腹	179	70	16.590			<0.001
腹腔镜	262	203

变量	β值	SE值	Wald值	P值	OR值	95%CI
孕次(>2次)	0.668	0.186	12.917	<0.001	1.951	1.355~2.808
SCC-Ag(≥1.5 μg/L)	0.704	0.172	16.809	<0.001	2.021	1.444~2.829
FIGO分期			20.942	<0.001
ⅠB1
ⅠB2	0.153	0.223	0.471	0.492	1.166	0.752~1.806
ⅠB3	0.659	0.270	5.960	0.015	1.933	1.139~3.282
ⅡA1	1.002	0.286	12.312	<0.001	2.723	1.556~4.765
ⅡA2	1.150	0.379	9.914	0.002	3.159	1.502~6.646
是否合并基础疾病(是)	0.624	0.293	4.529	0.033	1.867	1.051~3.318
影像学检查是否伴有危险因素(是)	0.691	0.292	5.616	0.018	1.997	1.127~3.537
术前行辅助化疗的疗程数			7.735	0.021
0
1	-0.910	0.340	7.184	0.007	0.402	0.207~0.783
2	-0.567	0.515	1.212	0.271	0.567	0.207~1.556
手术路径(腹腔镜)	0.778	0.182	18.242	<0.001	2.177	1.524~3.112