| Objective: Our study retrospectively analyzed the clinical effectiveness of Locally Advanced Cervical Cancer(LACC)patients and explored the related prognostic factors.At the same time,we also established a survival prediction model to provide guidance for clinical diagnosis and treatment.Methods: A retrospective study was carried out on 419 patients with FIGO stage IB2-IVA who were admitted into our department from January 2009 to December 2016.The standard treatment was pelvic external irradiation combined with concurrent chemotherapy and brachytherapy.The dose of pelvic external irradiation was 45-50 Gy,2.0 per time,5 times a week.The treatment of concurrent chemotherapy contained cisplatin 40-50mg/ week or paclitaxel 60mg/ week was given during radiotherapy.Brachytherapy was generally placed after pelvic external irradiation with a dose of 30Gy/6Gy/5F,1-2 times a week.Neoadjuvant chemotherapy and consolidation chemotherapy contained paclitaxel combined with cisplatin for 2-4 courses.The collected indicators included age,FIGO stage,pathological type,histological grade,hemoglobin,tumor size,lymph node metastasis,neoadjuvant chemotherapy,and consolidation chemotherapy.The Overall Survival(OS)and Disease-free Survival(DFS)were followed up by inpatient system,telephone and outpatient department.SPSS 23.0 version was used to analyze the data.The measurement data that conformed to the normal distribution were represented by the mean plus and minus the standard deviation,and those that did not conform to the normal distribution were represented by the median.Kaplan-Meier method was used to calculate the survival rate,and Cox risk regression model was used to analyze the survival prognosis factors of LACC.At the same time,P< 0.05 was statistically significant.We used the R language to proceed subgroup analysis and map the forest plots.Then we also used the R language to construct the Nomogram graph of the survival prediction model.The accuracy of the model was evaluated by using Concordance index(C-index),Receiver Operating Characteristic(ROC)curve and calibration curve.Results: The 5-year overall survival rate was 73.3% and the 5-year disease-free survival rate was 71.8%.Univariate analysis showed that the consolidation chemotherapy,clinical stage,lymph node metastasis,histological grade,tumor size and pathological type had statistical significance with OS and DFS(P<0.05).Age and neoadjuvant chemotherapy had no statistical significance with OS and DFS in LACC patients(P>0.05).Multivariate analysis showed that the clinical stage,lymph node metastasis,pathological type and consolidation chemotherapy had statistical significance with OS and DFS of patients with LACC(P <0.05).According to the subgroup analysis of whether consolidation chemotherapy was performed or not,OS and DFS of patients undergoing consolidation chemotherapy had statistical significance with tumor size,hemoglobin,III/IVA stage,pathological type(P<0.05).Lymph node metastasis,whether age old or not and all histological grades had statistical significance with OS of patients.At the same time.Age >50,whether lymph node metastasized or not and all histological grades were statistically significant with DFS of patients(P<0.05).We constructed DFS and OS prognostic models for LACC patients using consolidation chemotherapy,pathological type,lymph node metastasis and clinical stage.The c-index was greater than 0.70,simultaneously the calibration curve also showed that the model had good predictive performance and the Area Under Curves(AUC)with 1,3 and 5years were greater than 0.73.Conclusion: Clinical stage,consolidation chemotherapy,lymph node metastasis and pathological type obviously affected the prognosis of patients with LACC.For patients with LACC,consolidation chemotherapy can improve the prognosis and survival rate of patients.The model constructed based on these four prognostic factors had good prognosis prediction performance and can provide guidance for patients’ clinical treatment decisions. |
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