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Postoperative Nomogram Predicting Risk of Recurrence After Radical Hysterectomy for Early-Stage Cervical Cancer
  1. Mi-Kyung Kim, MD*,
  2. Hoenil Jo, MD*,
  3. Hyoun-Joong Kong, PhD,
  4. Hee Chan Kim, PhD,
  5. Jae Weon Kim, MD, PhD*,,
  6. Yong-Man Kim, MD, PhD§,
  7. Yong-Sang Song, MD, PhD*,,
  8. Soon-Beom Kang, MD, PhD*,
  9. Jung-Eun Mok, MD, PhD and
  10. Hyo Pyo Lee, MD, PhD
  1. * Department of Obstetrics and Gynecology, College of Medicine,
  2. Institute of Medical and Biological Engineering, Medical Research Center,
  3. Cancer Research Institute, Seoul National University, Seoul, Korea;
  4. § Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asian Medical Center, Seoul, Korea;
  5. Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea; and
  6. Department of Obstetrics and Gynecology, Konkuk University Hospital, Seoul, Korea.
  7. Urology, and
  8. 7th Research Laboratory, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China.
  1. Address correspondence and reprint requests to Jae Weon Kim, MD, PhD, Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Republic of Korea. E-mail: kjwksh{at}snu.ac.kr.

Abstract

Objective: The aim of this study was to develop a nomogram for predicting the 5-year disease-free survival (DFS) after radical hysterectomy for early-stage cervical cancer.

Patients and Methods: An institutional database of 275 consecutive patients treated at Seoul National University Hospital for stage I to stage IIA cervical cancer was used to develop a nomogram based on Cox proportional hazards regression model. The developed nomogram was internally validated with bootstrapping, and performance was assessed by concordance index and a calibration curve. External validation was also performed using an independent data set of patients from Asan Medical Center.

Results: From Cox regression analysis, disease stage, number of positive lymph nodes, parametrial involvement, and depth of invasion were identified as independent risk factors for disease recurrence (P < 0.05). The nomogram incorporating these factors appeared to be accurate and predicted the outcomes better than the International Federation of Gynecology and Obstetrics stage alone (concordance index, 0.858 compared with 0.719; P = 0.001). When applied to a separate validation set, the nomogram also showed similar predictive accuracy (concordance index, 0.879).

Conclusion: We have developed a nomogram that can predict the recurrence risk in patients with early-stage cervical cancer after surgery, which was internally and externally validated.

  • Cervical cancer
  • Nomogram
  • Prognosis
  • Radical hysterectomy

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Footnotes

  • M.K.K. and H.J. contributed equally to this work.

  • The authors have no potential conflicts of interest.

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