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Abstract
Introduction/Background Outcomes are poor for cervical cancer (CC) patients with metastatic within one year after successfully completing the treatment, and no well-established risk model is available for the disease. This study aimed to establish an effective risk nomogram to predict the early distant metastasis (EDM) probability of CC patients treated with radical radiotherapy to aid individualized clinical decision-making.
Methodology Biopsy-confirmed CC patients received radical radiotherapy with or without chemotherapy between December 2018 and January 2021 were enrolled at Fujian Cancer Hospital. EDM was defined as tumor distant metastasis occurs less than one year after finishing radical radiotherapy. Clinical variables and inflammatory index were analyzed based on univariate and multivariate logistical regressions. Finally, age, tumor size, and chemotherapy status were used to build a multifactorial nomogram. The nomogram efficacy was evaluated by concordance indexes (C-indexes) and calibration curves. Patients were divided into high-and low risk groups based on nomogram points. The optimal cut-off value for all continuous variables was calculated using X-tile.
Results A total of 489 study patients were included and data of 14 clinical features were collected. 36 (7.36%) patients had EDM. Age below 51 (OR=2.298, P<0.001), tumor maximum diameter above 4.5cm (OR =3.817, P<0.001), and radiotherapy only (OR=3.319, P<0.001) were independent risk factors for patients with EDM by Multivariate analyses. A scoring system for the EDM prediction showed good discrimination and calibration (concordance index of 0.701). According to Kaplan-Meier curve of risk score, patients with high risk were more prone to get EDM (p<0.01).
Conclusion This is the first research to focus on EDM in CC patients. We have developed a robust scoring system that can predict the risk of EDM in CC patients received radiotherapy or combined with chemotherapy. Our nomogram might allow screening out appropriate cases for consolidation therapy and more intensive follow-up.
Disclosures The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.