| Research background: Cervical cancer is one of the most common malignancies and the fourth leading cause of cancer-related death in women,among whom the prognosis of patients with recurrent and metastatic cervical cancer is even worse,and there is an urgent need for an individualized diagnosis and treatment regimen for patients with advanced disease,thereby improving the quality of life and survival.With the continuous development of cancer diagnosis and treatment,the age of onset of cervical cancer has decreased from 60 to 50 years in the early 20 th century.There have been several studies focusing on the prognosis of older and younger patients with cervical cancer,and there is still a lack of systematic research on the prognostic factors of metastatic cervical cancer(MCEC)in young and middle-aged women(< 50years).In this study,we aimed to clarify the independent prognostic factors of MCEC patients aged < 50 years and established nomogram to predict their prognosis,in order to provide some reference for clinicians to make personalized treatment regimens.Objective: Construction of survival prediction model for young and middle-aged patients(<50 years old)with metastatic cervical cancer.Methods: The data of young and middle-aged MCEC patients confirmed by pathology between 2004 and 2015 were obtained from the US Surveillance,epidemiology,and end results(SEER)database,including complete clinical data and survival data.Eligible patients were randomized in a 7:3 ratio into a training cohort and a validation cohort.Using univariate and multivariate Cox regression analysis to determine the independent prognostic factors of young and middle-aged MCEC patients to construct a Nomogram to predict 12-month,24-month and 36-month overall survival(OS)in young and middle-aged MCEC patients.Receiver operating characteristic curve,calibration curve and decision curve analysis(DCA)were used to evaluate the predictive accuracy,discriminative ability and clinical utility of the model.Patients were divided into low,intermediate and high mortality risk subgroups by X-tile software,and Kaplan Meier survival analysis was performed.In addition,a web-based survival calculator was developed,which was based on nomograms.Results:1.The study finally included 616 young and middle-aged patients with MCEC and was divided into a training cohort(419)and a validation cohort(176)in a 7:3 ratio.Univariate Cox regression analysis showed that chemotherapy,histological type,race,radiotherapy,surgery,T stage,and tumor size were prognostic factors in young and middle-aged MCEC patients(p < 0.05),whereas after multivariate Cox regression analysis,race,tumor size,T stage,chemotherapy,radiotherapy,and surgery were identified as independent prognostic factors in this population(p < 0.05).2.To construct a nomogram for young and middle-aged patients with MCEC based on 6 independent prognostic factors that have been identified.The area under curve(AUC)values of model 12-month,24 month,and 36 month OS were 0.741,0.739,and 0.731 in the training cohort and 0.760,0.695,and 0.696 in the validation cohort,respectively.The calibration curve observation of nomogram showed that the prediction results in the training cohort and validation cohort were highly consistent with the actual results,and,furthermore,the DCA curve also demonstrated the strong clinical applicability of the nomogram model in the prognosis prediction of young and middle-aged patients with MCEC.In addition,an interactive Web-based Nomogram has also been constructed,which can be accessed through the online URL(https://shubei11.shinyapps.io/Youngcervicalnomogram/).When the user enters the corresponding clinical characteristics and specific time points through the online website,the corresponding survival curve and estimated survival probability can be generated.3.Patients were divided into low mortality risk subgroup,medium mortality risk subgroup and high mortality risk subgroup by X-tile software.231 points and 308 points are used as cut-off values.Patients with a score below 231 belong to the low mortality risk subgroup,patients with a score of 231 to 308 belong to the moderate death risk subgroup,and patients with a score of more than 308 belong to the high mortality risk subgroup.After Kaplan-Meier survival analysis,there were significant differences in the OS of patients in different groups,and the results showed that when patients were classified into low-risk subgroups,the prognosis was better,in other words,the prognosis of patients in the high-risk group was worse than that of patients in the low-risk group.Conclusion: In this study,a novel web-based nomogram was developed to predict the probability of OS in young and middle-aged(< 50 years)MCEC patients,which will facilitate clinicians personalized survival assessment and clinical management of patients. |
PDF Full Text Request