Original Research ARTICLE
Score for the overall Survival Probability of patients with first-diagnosed distantly metastatic cervical cancer: A Novel Nomogram-Based Risk Assessment System
- 1Shilong Zhang, China
- 2Institute of Fudan-Minhang Academic Health System, Minhang Branch, Zhongshan hospital, Fudan University, China
- 3Shanghai Xuhui Central Hospital, China
- 4Shandong Normal University, China
Background: Metastatic cervical cancer (mCEC) is the end stage of cervical cancer. This study aimed to establish and validate a nomogram to predict the overall survival (OS) of mCEC patients.
Methods: We investigated the Surveillance, Epidemiology, and End Results (SEER) database for mCEC patients diagnosed between 2010 and 2014. Univariate and multivariable Cox analyses was performed to select the clinically important predictors of OS when developing the nomogram. The performance of nomogram was validated with Harrell’s concordance index (C-index), calibration curves, receiver operating characteristic curve (ROC), and decision curve analysis (DCA).
Results: 1,252 mCEC patients were included and were divided into training (n = 880) and independent validation (n = 372) cohorts. Age, race, pathological type, histology grade, radiotherapy, and chemotherapy were independent predictors of OS and used to develop the nomogram for predicting 1- and 3-year OS. This nomogram had a C-index of 0.753 (95% confidence interval [CI]: 0.780-0.726) and 0.751 (95% CI: 0.794-0.708)
in the training and the validation cohorts, respectively. Internal and external calibration curves indicated satisfactory agreement between nomogram prediction and actual survival, and DCA indicated its clinical usefulness. Furthermore, a risk stratification system was established that was able to accurately stratify mCEC patients into three risk subgroups with significantly different prognosis.
Conclusions: We constructed the first nomogram and corresponding risk classification system to predict the OS of mCEC patients. These tools showed satisfactory accuracy, and clinical utility, and could aid in patient counseling and individualized clinical decision-making.
Keywords: nomogram, metastatic cervical cancer, SEER, prognosis, overall survival, prediction
Received: 16 Jun 2019;
Accepted: 07 Oct 2019.
Copyright: © 2019 Zhang, Wang, Li, Wang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mx. Lishun Wang, Institute of Fudan-Minhang Academic Health System, Minhang Branch, Zhongshan hospital, Fudan University, Shanghai, China, firstname.lastname@example.org