Wang Tinglu, Wei Jinchen, Jiang Li, Huang Lulu, Huang Tingting, Ma Shanshan, Huang Qiufeng, Zhang Yong, Wu Fang
Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Cancer Med. 2024 Dec;13(24):e70492. doi: 10.1002/cam4.70492.
The indications of prophylactic extended-field radiotherapy (EFRT) remain uncertain. This study aims to identify the risk factors for para-aortic lymph node (PALN) metastases in locally advanced cervical cancer (LACC) and determine which part of patients may benefit from prophylactic EFRT.
Between January 2015 and July 2023, a single-center retrospective analysis was performed on patients with stages IB3 and IIA2-IVA cervical cancer. Lymph node involvement was assessed using positron emission tomography/computed tomography (PET/CT). Risk factors were evaluated by logistic regression. A prediction nomogram model was developed and validated.
Among 329 patients, 64 (19.5%) had PALN metastases. Univariate analysis indicated that tumor size > 5.3 cm, tumor maximum standardized uptake value (SUVmax) > 9.8, bilateral pelvic lymph node (PLN) metastases, the number of positive PLNs ≥ 3, and T3-T4 stages were related to PALN metastases. After multivariate logistic analysis, it was found that tumor size > 5.3 cm (odds ratio [OR] = 3.129, 95% confidence interval [CI] = 1.536-6.374, p = 0.002), and the number of positive PLNs ≥ 3 (OR = 11.260, 95% CI = 3.506-36.158, p < 0.001) were independent risk factors. The C-index of the nomogram was 0.886 (95% CI = 0.844-0.927). The calibration plot showed that the nomogram was well-fitted. Decision curve analysis (DCA) exhibited excellent clinical utility.
Tumor size > 5.3 cm and the number of positive PLNs ≥ 3 are independent risk factors of PALN metastases. The nomogram shows pretty good accuracy, which may provide a valuable reference for guiding patients who are very likely to develop PALN metastases to receive prophylactic EFRT.
预防性扩大野放射治疗（EFRT）的适应证仍不明确。本研究旨在确定局部晚期宫颈癌（LACC）腹主动脉旁淋巴结（PALN）转移的危险因素，并确定哪些患者可能从预防性EFRT中获益。
2015年1月至2023年7月，对IB3期和IIA2-IVA期宫颈癌患者进行单中心回顾性分析。采用正电子发射断层扫描/计算机断层扫描（PET/CT）评估淋巴结受累情况。通过逻辑回归评估危险因素。建立并验证了预测列线图模型。
329例患者中，64例（19.5%）发生PALN转移。单因素分析表明，肿瘤大小>5.3 cm、肿瘤最大标准化摄取值（SUVmax）>9.8、双侧盆腔淋巴结（PLN）转移、阳性PLN数量≥3以及T3-T4期与PALN转移有关。多因素逻辑分析后发现，肿瘤大小>5.3 cm（比值比[OR]=3.129，95%置信区间[CI]=1.536-6.374，p=0.002）和阳性PLN数量≥3（OR=11.260，95%CI=3.506-36.158，p<0.001）是独立危险因素。列线图的C指数为0.886（95%CI=0.844-0.927）。校准图显示列线图拟合良好。决策曲线分析（DCA）显示出良好的临床实用性。
肿瘤大小>5.3 cm和阳性PLN数量≥3是PALN转移的独立危险因素。列线图显示出相当高的准确性，可为指导极有可能发生PALN转移的患者接受预防性EFRT提供有价值的参考。
