Liu Linying, Lin Jie, Li Anyang, Xie Ning, Zheng Jianfeng, Xiao Youping, Lin Xuefen, Wu Shizhong, Yu Haijuan, Sun Yang
Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuma Road, Fuzhou 350014, China.
Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China.
Curr Oncol. 2025 Jun 16;32(6):355. doi: 10.3390/curroncol32060355.
This study aimed to identify the prognostic value of tumor invasion distance (TID) based on MRI findings in cervical-cancer (CC) patients treated with radiotherapy (RT). : A total of 218 CC patients diagnosed at Fujian Cancer Hospital from December 2018 to December 2019 were included in the study. Cox regression analyses were conducted to identify independent prognostic factors for overall survival (OS), including low 1/3 vaginal involvement, a longer TID, and RT without chemotherapy. These factors were subsequently used to construct a nomogram for individualized risk prediction. Kaplan-Meier survival analysis was employed to evaluate survival outcomes and establish a risk stratification system. The performance of the new stratification was assessed using the linear trend χ test, Akaike information criterion, and Harrell's concordance index. : A longer TID was associated with worse 3-year OS ( < 0.001, HR: 3.42, 95% CI: 1.67-7.00). A longer TID, lower 1/3 vaginal involvement, and concurrent chemotherapy were independent prognostic survival factors for CC patients. Compared with the 2018 FIGO staging system, the new risk stratification system provided better monotonicity with a higher linear trend χ value (28.03 vs. 9.35), better discriminatory ability with smaller Akaike information criterion (312 vs. 331), and a greater Harrell C statistic (0.74 vs. 0.65) for predicting 3-year OS. : This was the first study to demonstrate the prognostic value of TID in CC patients who received RT. The new risk stratification system based on TID could complement the 2018 FIGO staging system in identifying high-risk patients for more intense treatment and care. Further prospective research with larger samples is warranted to confirm the significance of TID for CC patients treated with RT.
本研究旨在基于MRI结果确定肿瘤浸润深度（TID）对接受放疗（RT）的宫颈癌（CC）患者的预后价值。本研究纳入了2018年12月至2019年12月在福建肿瘤医院确诊的218例CC患者。进行Cox回归分析以确定总生存期（OS）的独立预后因素，包括阴道下1/3受累、TID较长以及单纯放疗。随后使用这些因素构建用于个体风险预测的列线图。采用Kaplan-Meier生存分析评估生存结果并建立风险分层系统。使用线性趋势χ检验、赤池信息准则和Harrell一致性指数评估新分层的性能。TID较长与3年OS较差相关（P<0.001，HR：3.42，95%CI：1.67-7.00）。TID较长、阴道下1/3受累以及同步化疗是CC患者的独立预后生存因素。与2018年国际妇产科联盟（FIGO）分期系统相比，新的风险分层系统具有更好的单调性，线性趋势χ值更高（28.03对9.35），具有更好的鉴别能力，赤池信息准则更小（312对331），并且在预测3年OS时Harrell C统计量更大（0.74对0.65）。这是第一项证明TID对接受RT的CC患者具有预后价值的研究。基于TID的新风险分层系统可以在识别高危患者以进行更强化的治疗和护理方面补充2018年FIGO分期系统。有必要进行进一步的大样本前瞻性研究以证实TID对接受RT的CC患者的意义。
