Guo Qu, Gao Yufeng, Lin Yaying, Li Weimin, Zhang Zhenyu, Mao Yurong, Xu Xizhong
Department of Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, China.
Wuxi Medical College, Jiangnan University, Wuxi, China.
Arch Gynecol Obstet. 2024 May;309(5):2079-2087. doi: 10.1007/s00404-024-07385-6. Epub 2024 Feb 15.
To develop predictive nomograms of lymph vascular space invasion (LVSI) in patients with early-stage cervical cancer.
We identified 403 patients with cervical cancer from the Affiliated Hospital of Jiangnan University from January 2015 to December 2019. Patients were divided into the training set (n = 242) and the validation set (n = 161), with patients in the training set subdivided into LVSI (+) and LVSI (-) groups according to postoperative pathology. Preoperative hematologic indexes were compared between the two subgroups. Univariate and multivariate logistic regression analyses were used to analyze the independent risk factors for LVSI, from which a nomogram was constructed using the R package.
LVSI (+) was present in 94 out of 242 patients in the training set, accompanied by a significant increase in the preoperative squamous cell carcinoma antigen (SCC), white blood cells (WBC), neutrophil (NE), platelet (PLT), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), and tumor size (P < 0.05). Univariate analysis showed that SCC, WBC, NE, NLR, PLR, SII, and tumor size were correlated with LVSI (P < 0.05), and multivariate analysis showed that tumor size, SCC, WBC, and NLR were independent risk factors for LVSI (P < 0.05). A nomogram was correspondingly established with good performance in predicting LVSI [training: ROC-AUC = 0.845 (95% CI: 0.731-0.843) and external validation: ROC-AUC = 0.704 (95% CI: 0.683-0.835)] and high accuracy (training: C-index = 0.787; external validation: C-index = 0.759).
The nomogram based on preoperative tumor size, SCC, WBC, and NLR had excellent accuracy and discriminative capability to assess the risk of LVSI in early-stage cervical cancer patients.
建立早期宫颈癌患者淋巴血管间隙浸润（LVSI）的预测列线图。
我们从江南大学附属医院中确定了2015年1月至2019年12月期间的403例宫颈癌患者。将患者分为训练集（n = 242）和验证集（n = 161），训练集中的患者根据术后病理分为LVSI（+）组和LVSI（-）组。比较两个亚组术前的血液学指标。采用单因素和多因素逻辑回归分析来分析LVSI的独立危险因素，并使用R软件包构建列线图。
训练集中242例患者中有94例存在LVSI（+），同时术前鳞状细胞癌抗原（SCC）、白细胞（WBC）、中性粒细胞（NE）、血小板（PLT）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、全身炎症指数（SII）和肿瘤大小显著升高（P < 0.05）。单因素分析显示，SCC、WBC、NE、NLR、PLR、SII和肿瘤大小与LVSI相关（P < 0.05），多因素分析显示肿瘤大小、SCC、WBC和NLR是LVSI的独立危险因素（P < 0.05）。相应地建立了一个列线图，其在预测LVSI方面具有良好的性能[训练集：ROC-AUC = 0.845（95%CI：0.731 - 0.843），外部验证：ROC-AUC = 0.704（95%CI：0.683 - 0.835）]且准确性高（训练集：C指数 = 0.787；外部验证：C指数 = 0.759）。
基于术前肿瘤大小、SCC、WBC和NLR的列线图在评估早期宫颈癌患者LVSI风险方面具有出色的准确性和鉴别能力。
