Li Ernan, Ni Huanjuan
Dependent of Obstetrics and Gynecology, Northern Theater Command General Hospital, Shengyang, China.
Prev Med Rep. 2024 Mar 26;41:102700. doi: 10.1016/j.pmedr.2024.102700. eCollection 2024 May.
To identify key clinical factors affecting the survival of elderly patients with early-stage cervical cancer and to construct a nomogram for predicting their prognosis.
Patients (aged ≥ 65 years old) diagnosed with cervical cancer between 2004 and 2015 at clinical stages IA to IIA were included in this study. Diagnosis was confirmed via pathological examination, and the cases were randomly divided into a training or a validation group in a 7:3 ratio. Univariate and multivariable Cox regression analyses were performed to identify independent factors affecting the prognosis of elderly early-stage cervical cancer patients, based on which a nomogram was constructed to predict their 12-, 24- and 36-month overall survival (OS). The nomogram's performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) curves.
A total of 686 patients were identified as eligible and assessed. Multivariable Cox proportional hazard regression analysis revealed that age, tumor diameter, marital status and surgical intervention were independent prognostic factors for elderly individuals with early-stage cervical cancer, which were then used to construct the nomogram. The calibration curves showed a strong correlation between predicted and observed survival rates, and Kaplan-Meier survival curves for different risk subgroups demonstrated significant survival differences (P < 0.001). DCA confirmed the nomogram's clinical utility in predicting the prognosis of elderly patients with early-stage cervical cancer.
The prognostic model developed in this study can accurately predict the OS of elderly patients with early-stage cervical cancer, showing high concordance with actual clinical outcomes.
确定影响老年早期宫颈癌患者生存的关键临床因素，并构建预测其预后的列线图。
本研究纳入2004年至2015年间临床分期为IA至IIA期、年龄≥65岁的宫颈癌患者。通过病理检查确诊，病例按7:3的比例随机分为训练组或验证组。进行单因素和多因素Cox回归分析，以确定影响老年早期宫颈癌患者预后的独立因素，并据此构建列线图以预测其12个月、24个月和36个月的总生存期（OS）。使用受试者工作特征（ROC）曲线、校准曲线和决策曲线分析（DCA）曲线评估列线图的性能。
共确定686例符合条件并进行评估的患者。多因素Cox比例风险回归分析显示，年龄、肿瘤直径、婚姻状况和手术干预是老年早期宫颈癌患者的独立预后因素，据此构建列线图。校准曲线显示预测生存率与观察生存率之间有很强的相关性，不同风险亚组的Kaplan-Meier生存曲线显示出显著的生存差异（P<0.001）。DCA证实了列线图在预测老年早期宫颈癌患者预后方面的临床实用性。
本研究开发的预后模型能够准确预测老年早期宫颈癌患者的总生存期，与实际临床结果具有高度一致性。
