ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1606685
Development of a Predictive Tool for Long-term Prognosis in Clear Cell Adenocarcinoma of the Cervix: A Large Population-based Real-world Study
Provisionally accepted
- 1The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- 2Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, Guangdong Province, China
- 3Fujian Provincial Cancer Hospital, Fuzhou, Fujian Province, China
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Background: Clear cell adenocarcinoma of the cervix (CCAC) is a rare malignancy without a well-established prognostic model. Our study aimed to develop and validate a nomogram to estimate overall survival in CCAC patients.We collected data on 630 CCAC patients from the Surveillance, Epidemiology, and End Results (SEER) database . Missing clinicopathological data were imputed using the Missforest package. The imputed dataset served as the training cohort, while the dataset with missing values removed acted as the validation cohort. The nomogram's performance was assessed through discriminative ability, calibration, C-index, AUC, and calibration plots. Clinical benefits were compared against International Federation of Gynecology and Obstetrics (FIGO) staging using decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI).The nomogram, based on nine variables, demonstrated strong discriminative power with C-indexes of 0.82 (training) and 0.81 (validation), and AUCs exceeding 0.80 for both sets. Calibration plots showed a strong agreement between the nomogram's predictions and actual outcomes in both cohorts. The NRI values for the training set were 0.21 for 3-year, 0.20 for 5-year, and 0.30 for 10-year Overall Survival (OS) predictions, and for the validation set were 0.34 for 3-year, 0.25 for 5-year, and 0.31 for 10-year OS predictions. The IDI results for the training set were 0.17 across 3-, 5-, and 10-year OS predictions, and for the validation set were 0.21 for 3-year, 0.17 for 5-year, and 0.15 for 10-year OS predictions. The nomogram significantly outperformed the FIGO criteria (p < 0.01), and DCA highlighted its clinical utility and superiority in identifying high-risk patients.The nomogram, integrating treatment data, was successfully developed and validated to assist clinicians in assessing the prognosis of CCAC patients, showing superior performance to FIGO criteria in predicting overall survival.
Keywords: Clear cell adenocarcinoma of the cervix, nomogram, os, FIGO stage, risk stratification
Received: 06 Apr 2025; Accepted: 22 May 2025.
Copyright: © 2025 Wang, Ouyang, Chen, Bai, Cao, Cai and Xu. 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) or licensor 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: Qunrong Cai, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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