Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
Sci Rep. 2022 Jun 14;12(1):9873. doi: 10.1038/s41598-022-13616-0.
To develop and validate a prognostic model, including the minor lymphatic pathway (internal iliac and presacral nodes).
Retrospective cohort.
Locally advanced cervical cancer underwent concurrent chemoradiotherapy.
397 and 384 patients in the development and validation data set.
Our new nodal staging system with the minor lymphatic pathway.
Distant metastases.
Cox regression; net reclassification improvement (NRI) and decision curve analysis (DCA). Our new nodal system was the strongest predictor. The predictors in the final model were new nodal system, tumor stage, adenocarcinoma, initial hemoglobin, tumor size and age. The nodal system and the pretreatment model had concordance indices of 0.661 and 0.708, respectively, with good calibration curves. Compared to the OUTBACK eligibility criteria, the nodal system showed NRI for both cases (22%) and controls (16%). The pretreatment model showed NRI for cases (31%) and controls (18%). DCA in both models showed threshold probability of 15% and 12%, respectively, when compared with 24% in OUTBACK eligibility criteria. Our new nodal staging system and the pretreatment model could differentiate between high-risk and low-risk patients, thus facilitating decisions to provide more aggressive treatment to prevent distant metastases.
开发和验证一个包括小淋巴通路（髂内和骶前淋巴结）的预后模型。
回顾性队列研究。
局部晚期宫颈癌患者接受同期放化疗。
发展和验证数据集分别为 397 例和 384 例患者。
我们的新淋巴结分期系统包括小淋巴通路。
远处转移。
Cox 回归；净重新分类改善（NRI）和决策曲线分析（DCA）。我们的新淋巴结系统是最强的预测因子。最终模型中的预测因子包括新的淋巴结系统、肿瘤分期、腺癌、初始血红蛋白、肿瘤大小和年龄。新的淋巴结系统和预处理模型的一致性指数分别为 0.661 和 0.708，校准曲线良好。与 OUTBACK 入选标准相比，淋巴结系统对病例（22%）和对照（16%）均显示出 NRI。预处理模型对病例（31%）和对照（18%）显示出 NRI。与 OUTBACK 入选标准中的 24%相比，两个模型中的 DCA 均显示出阈值概率为 15%和 12%。我们的新淋巴结分期系统和预处理模型可以区分高危和低危患者，从而有助于做出提供更积极治疗以预防远处转移的决策。
