Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cancer Res Treat. 2021 Jan;53(1):233-242. doi: 10.4143/crt.2020.159. Epub 2020 Sep 14.
This study aimed to investigate the factors associated with chemoresistance to neoadjuvant chemotherapy (NACT) followed by radical hysterectomy (RH) and construct a nomogram to predict the chemoresistance in patients with locally advanced cervical squamous carcinoma (LACSC).
This retrospective study included 516 patients with International Federation of Gynecology and Obstetrics (2003) stage IB2 and IIA2 cervical cancer treated with NACT and RH between 2007 and 2017. Clinicopathologic data were collected, and patients were assigned to training (n=381) and validation (n=135) sets. Univariate and multivariate analyses were performed to analyze factors associated with chemoresistance to NACT. A nomogram was built using the multivariate logistic regression analysis results. We evaluated the discriminative ability and accuracy of the model using a concordance index and a calibration curve. The predictive probability of chemoresistance to NACT was defined as > 34%.
Multivariate analysis confirmed menopausal status, clinical tumor diameter, serum squamous cell carcinoma antigen level, and parametrial invasion on magnetic resonance imaging before treatment as independent prognostic factors associated with chemoresistance to NACT. The concordance indices of the nomogram for training and validation sets were 0.861 (95% confidence interval [CI], 0.822 to 0.900) and 0.807 (95% CI, 0.807 to 0.888), respectively. Calibration plots revealed a good fit between the modelpredicted probabilities and actual probabilities (Hosmer-Lemeshow test, p=0.597). Furthermore, grouping based on the nomogram was associated with progression-free survival.
We developed a nomogram for predicting chemoresistance in LACSC patients treated with RH. This nomogram can help physicians make clinical decisions regarding primary management and postoperative follow-up of the patients.
本研究旨在探讨新辅助化疗（NACT）联合根治性子宫切除术（RH）后局部晚期宫颈鳞癌（LACSC）患者化疗耐药的相关因素，并构建预测模型。
本回顾性研究纳入 2007 年至 2017 年期间接受 NACT 和 RH 治疗的 516 例国际妇产科联合会（2003 年）IB2 期和 IIA2 期宫颈癌患者。收集临床病理资料，并将患者分为训练集（n=381）和验证集（n=135）。采用单因素和多因素分析方法分析与 NACT 耐药相关的因素。利用多因素逻辑回归分析结果建立列线图。通过一致性指数和校准曲线评估模型的判别能力和准确性。将 NACT 耐药的预测概率定义为>34%。
多因素分析证实，绝经状态、临床肿瘤直径、治疗前血清鳞状细胞癌抗原水平和磁共振成像上的宫旁侵犯是与 NACT 耐药相关的独立预后因素。训练集和验证集的列线图一致性指数分别为 0.861（95%置信区间 [CI]，0.822 至 0.900）和 0.807（95% CI，0.807 至 0.888）。校准图显示模型预测概率与实际概率之间具有良好的拟合度（Hosmer-Lemeshow 检验，p=0.597）。此外，根据列线图分组与无进展生存相关。
我们为接受 RH 治疗的 LACSC 患者建立了预测化疗耐药的列线图。该列线图有助于医生做出关于患者初始治疗和术后随访的临床决策。
