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Comprehensive Evaluation of the Prognostic Value Ofsystemic Inflammation-Nutrition Indexes in Locally Advanced Cervical Cancer: A Retrospective Study
25 Pages Posted: 19 Mar 2024
More...Abstract
Background: Inflammation and nutrition play important roles in tumorigenesis and therapeutic responses. We aimed to investigate the prognostic value of systemic inflammation-nutrition indexes and develop a novel nomogram for locally advanced cervical cancer (LACC) patients receiving radiotherapy.
Methods: This retrospective study analyzed clinical data collected from our institute encompassing 375 patients with LACC between 2010 and 2020. Enrolled patients were randomly divided into training and validation cohorts. Univariate, multivariate, and LASSO Cox regression analyses were used to identify independent prognostic factors. Based on the identified prognostic factors, the nomogram was developed and verified to predict the 3-, 4-, and 5-year overall survival of patients with LACC. The discrimination and calibration of the nomogram were assessed using the C-index, ROC curve, and the calibration curve. DCA, IDI and NRI were used to assess the superiority and clinical utility of the nomogram.
Findings: The 3-, 4-, and 5-year overall survival rates were 86.9%, 83.6%, and 76.4% in the total cohort. Prognostic factors of basophil percentage, platelet/lymphocyte ratio (PLR), CA153, SCC-Ag, controlling nutritional status (COUNT) score, histological subtypes and tumor stage were ultimately selected to construct the nomogram. The newly developed nomogram demonstrated predictive performance. The AUC values at 3-, 4-, and 5-year were 0.77, 0.79, and 0.77 in the training cohort and 0.62, 0.68, and 0.72 in the validation cohort, respectively. Calibration curves demonstrated satisfactory concordance between predicted survival probabilities and actual observations. ROC curves, C-index value, IDI, NRI, and DCA collectively indicated the superiority of the nomogram over the existing International Federation of Gynecology and Obstetrics (FIGO) staging system. I
nterpretation: The novel nomogram, which can accurately predict probabilities of overall survival in patients with LACC, might help in clinical trial design and individual clinical decision-making.
Funding: Science and Technology Project of Shanghai Municipal Science and Technology Commission (No. 22Y31900500).
Declaration of Interest: The authors declare that the research was conducted without any conflict of interest.
Ethical Approval: A waiver of written informed consent was approved by the Ethics Committee of Shanghai Sixth People's Hospital because of the minimal risk of using the electronic medical record system. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Shanghai Sixth People's Hospital (protocol code 2022-KY-149(K) and 2022-10-20 of approval).
Keywords: Locally advanced cervical cancer, radiotherapy, nomogram, prognostic factors, inflammation, nutrition, hematologic parameters
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