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Development and validation of a nomogram for predicting overall survival in FIGO IB3-IIA2 cervical adenocarcinoma:
Yibao Huang1,2, Xiaofan Gao1,2, Zihan Li1,2
1Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Objective:
The prevalence of cervical adenocarcinoma has risen significantly, complicating management strategies for locally advanced stages. To address insufficient prognostic data for International Federation of Gynecology and Obstetrics (FIGO) stage IB3-IIA2 cervical adenocarcinoma after radical hysterectomy, this study developed a model to evaluate overall survival (OS).
Methods:
This retrospective cohort study enrolled patients with FIGO stage IB3-IIA2 cervical adenocarcinoma who underwent radical hysterectomy and platinum-based chemotherapy between March 2016 and December 2020. Baseline data were retrospectively collected from medical records, and follow-up outcomes were prospectively gathered. A Cox proportional hazards regression model was employed to identify the potential factors. A nomogram was developed to assess the probability of OS. The predictive accuracy was assessed using the receiver operating characteristic curve, calibration curve, and decision curve analysis. The Kaplan-Meier methodology was applied to generate the OS curve.
Results:
A total of 365 patients were enrolled, including 228 with FIGO stage IB3 and 137 with stage IIA2 disease. The median OS time was 57.8 months. The 1-year, 3-year, and 5-year OS rates were 97.2%, 90.1%, and 83.8%, respectively. Lymphovascular space invasion (hazard ratio [HR] 6.601; 95% confidence interval [CI] 3.012-14.468), surgical margin (HR 24.340; 95% CI 8.342-71.047), lymphocyte count (HR 3.937; 95% CI 2.499-6.202) and neutrophil-to-lymphocyte ratio (HR 1.224; 95% CI 1.111-1.348) were independently associated with OS. These significant variables were then integrated to formulate a nomogram for predicting 1-year, 3-year, and 5-year OS. The nomogram exhibited excellent and robust discrimination in both the training and validation sets, with area under the curve values of 0.788-0.980 across 1-5 years in both cohorts. Calibration curves indicated a high consistency between predicted probabilities and actual frequencies, whereas decision curve analysis curves confirmed significant clinical net benefit across a wide range of threshold probabilities.
Conclusion:
Patients with FIGO stage IB3-IIA2 cervical adenocarcinoma who exhibited lymphovascular space invasion, positive surgical margin, higher lymphocyte count, and higher neutrophil-to-lymphocyte ratio were at a higher risk of mortality. The nomogram-based prognostic model effectively predicted survival probabilities, serving as a tool for individualized management.
