Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
BMC Cancer. 2021 Apr 23;21(1):450. doi: 10.1186/s12885-021-08209-5.
To explore the factors that affect the prognosis of overall survival (OS) and cancer-specific survival (CSS) of patients with stage IIIC1 cervical cancer and establish nomogram models to predict this prognosis.
Data from patients in the Surveil-lance, Epidemiology, and End Results (SEER) programme meeting the inclusion criteria were classified into a training group, and validation data were obtained from the First Affiliated Hospital of Anhui Medical University from 2010 to 2019. The incidence, Kaplan-Meier curves, OS and CSS of patients with stage IIIC1 cervical cancer in the training group were evaluated. Nomograms were established according to the results of univariate and multivariate Cox regression models. Harrell's C-index, calibration plots, receiver operating characteristic (ROC) curves and decision-curve analysis (DCA) were calculated to validate the prediction models.
The incidence of pelvic lymph node metastasis, a high-risk factor for the prognosis of cervical cancer, decreased slightly over time. Eight independent prognostic variables were identified for OS, including age, race, marriage status, histology, extension range, tumour size, radiotherapy and surgery, but only seven were identified for CSS, with marriage status excluded. Nomograms of OS and CSS were established based on the results. The C-indexes for the nomograms of OS and CSS were 0.687 and 0.692, respectively, using random sampling of SEER data sets and 0.701 and 0.735, respectively, using random sampling of external data sets. The AUCs for the nomogram of OS were 0.708 and 0.705 for the SEER data sets and 0.750 and 0.750 for the external data sets, respectively. In addition, AUCs of 0.707 and 0.709 were obtained for the nomogram of CSS when validated using SEER data sets, and 0.788 and 0.785 when validated using external data sets. Calibration plots for the nomograms were almost identical to the actual observations. The DCA also indicated the value of the two models.
Eight independent prognostic variables were identified for OS. The same factors predicted CSS, with the exception of the marriage status. Both OS and CSS nomograms had good predictive and clinical application value after validation. Notably, tumour size had the largest contribution to the OS and CSS nomograms.
探索影响 IIIC1 期宫颈癌患者总生存（OS）和癌症特异性生存（CSS）预后的因素，并建立预测该预后的列线图模型。
根据纳入标准，从监测、流行病学和最终结果（SEER）计划中的患者数据中分类出训练组，并从 2010 年至 2019 年获得来自安徽医科大学第一附属医院的数据。评估训练组中 IIIC1 期宫颈癌患者的发病情况、Kaplan-Meier 曲线、OS 和 CSS。根据单因素和多因素 Cox 回归模型的结果建立列线图。计算 Harrell's C 指数、校准图、受试者工作特征（ROC）曲线和决策曲线分析（DCA）以验证预测模型。
盆腔淋巴结转移是宫颈癌预后的高危因素，其发病率随时间略有下降。确定了 8 个与 OS 相关的独立预后变量，包括年龄、种族、婚姻状况、组织学、扩展范围、肿瘤大小、放疗和手术，但仅确定了 7 个与 CSS 相关的变量，排除了婚姻状况。基于结果建立了 OS 和 CSS 的列线图。使用 SEER 数据集的随机抽样，OS 和 CSS 列线图的 C 指数分别为 0.687 和 0.692，使用外部数据集的随机抽样，OS 和 CSS 列线图的 C 指数分别为 0.701 和 0.735。OS 列线图的 AUC 分别为 0.708 和 0.705，SEER 数据集，0.750 和 0.750，外部数据集。此外，使用 SEER 数据集验证 CSS 列线图时，AUC 分别为 0.707 和 0.709，使用外部数据集验证时，AUC 分别为 0.788 和 0.785。校准图与实际观察结果几乎一致。DCA 也表明了两个模型的价值。
确定了 8 个与 OS 相关的独立预后变量。同样的因素预测 CSS，除了婚姻状况。OS 和 CSS 列线图在验证后均具有良好的预测和临床应用价值。值得注意的是，肿瘤大小对 OS 和 CSS 列线图的贡献最大。
