Establishment of prognostic nomogram in cervical cancer with hepatitis B virus infection: a retrospective study

This study aimed to identify prognostic factors and establish a nomogram for predicting overall survival (OS) in hepatitis B surface antigen-positive (HBsAg-positive) cervical cancer (CC) patients.

A retrospective analysis of 149 HBsAg-positive CC patients treated at Yunnan Cancer Hospital (2015-2017) was performed. Cox regression identified independent prognostic factors for nomogram development. The nomogram's predictive accuracy and discriminative capability were evaluated through Harrell's concordance index (C-index), calibration plots, and decision curve analysis, and its performance was compared to the International Federation of Gynecology and Obstetrics (FIGO) staging system. Internal validation was conducted using the bootstrap resampling method.

Multivariate Cox regression analyses identified tumor stage, baseline serum AST levels, antiviral therapy, lymph node status, and treatment modality as independent prognostic factors for patients with HBsAg-positive CC, all of which were incorporated into the nomogram for OS. The Harrell's C-index of nomogram was 0.817 (95% confidence interval [CI], 0.762-0.873), which was higher than that of FIGO staging system 0.700 (95% CI, 0.637-0.764, P < 0.001). Moreover, the nomogram showed superior performance in decision curve analysis (DCA) and a higher area under the curve (AUC) compared to the FIGO staging system. The calibration curve for survival probability exhibited good consistency between the probabilities and observed values. Grouping based on the nomogram's cutoff value showed that the high-risk group experienced significantly poorer OS than the low-risk group (P < 0.001).

This study established a nomogram for the preliminary prognostic evaluation of OS in HBsAg-positive CC patients. Further validation is required prior to its clinical application.