Beyond Sedlis—A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis

Levinson, Kimberly; Beavis, Anna; Purdy, Christopher; Rositch, Anne F.; Viswanathan, Akila; Wolfson, Aaron H.; Kelly, Michael G.; Tewari, Krishnansu S.; McNally, Leah; Guntupalli, Saketh R.; Ragab, Omar; Lee, Yi-Chun; Miller, David S.; Huh, Warner K.; Wilkinson, Kate; Spirtos, Nicola M.; Le, Linda Van; Casablanca, Yovanni; Holman, Laura L.; Waggoner, Steven; Fader, Amanda N.

doi:10.1016/j.ygyno.2021.06.017

Cited by 33 publications

(38 citation statements)

References 16 publications

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“…However, the prognostic model has been widely used in the prediction and evaluation of the prognosis of various tumour patients in recent years. 46–49 More importantly, the nomogram model showed higher accuracy than the TNM staging system. 50 In addition, the nomogram model constructed based on existing clinical data can personally predict the prognosis of patients and has great clinical application value.…”

Section: Discussionmentioning

confidence: 94%

Development and Validation of a Prediction Model for Predicting the Prognosis of Postoperative Patients with Hepatocellular Carcinoma

Liu¹,

Liu²,

Yu³

et al. 2022

IJGM

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Purpose The aims of this study were to identify the prognosis-related risk factors for HCC patients after surgery and to develop a predictive model by analysing the medical records of 152 HCC patients in our hospital. Patients and Methods Univariate Cox regression analysis was applied to identify potential risk factors for HCC patients after surgery and to determine independent prognosis-related risk factors by multivariate analysis. Subsequently, a nomogram model was developed based on all independent factors and was validated by a validation set. Calibration and receiver operating characteristic curves were employed to evaluate the accuracy of the model. Finally, decision curve analyses were used to assess its clinical utility. Results The univariate Cox regression analysis indicated that the patient’s age, sex, grade, different AJCC TNM stages, vascular invasion, lymphatic infiltration, and tumour size were potential prognostic-related risk factors for HCC patients (p < 0.2), and the findings of multivariate analysis revealed that grade, different AJCC TNM stages, vascular invasion, and lymphatic infiltration were independent prognostic-related risk factors for HCC patients (p < 0.05). Subsequently, we constructed a prognosis-related prediction model based on all independent prognostic predictors and validated it with internal and external validation sets. The validation results indicated that the prediction model showed good accuracy (AUC = 0.81, 0.728) and consistency. More importantly, decision curve analysis illustrated that the nomogram model is a practical tool for predicting prognosis. Conclusion This study found that grade, different AJCC TNM stages, vascular invasion, and lymphatic infiltration were independent prognosis-related predictors for HCC patients after surgery, and a nomogram model built on these predictors exhibited great accuracy and clinical usefulness.

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Section: Discussionmentioning

confidence: 94%

Development and Validation of a Prediction Model for Predicting the Prognosis of Postoperative Patients with Hepatocellular Carcinoma

Liu¹,

Liu²,

Yu³

et al. 2022

IJGM

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“…It was found that the combination of T and N substage resulted in improved prognostic discrimination, with T1N < 3 pLN having significantly better survival compared to T 2 N < 3 pLN /T 1-2 N ≥ 3 pLN , with recurrence rates of 11.6% and 35.8% in each group, and the predicted 5-year OS was 92% and 62%, respectively. Non-SCC, mainly adenocarcinoma, is considered to be a negative prognostic factor in uterine cervical cancer (20). And patients with non-SCC in the T2N + and T1N ≥ 3pLN group had poorer outcome compared to SCC, but not in the T1N < 3 pLN group, which may reflect the possible interaction between pathology and the tumor stage.…”

Section: Discussionmentioning

confidence: 98%

The Combination of T Stage and the Number of Pathologic Lymph Nodes Provides Better Prognostic Discrimination in Early-Stage Cervical Cancer With Lymph Node Involvement

Bai

Rong

et al. 2021

Front. Oncol.

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ObjectiveStage I and II cervical cancer with pelvic and/or para-aortic lymph node (LN) metastases are upstaged to stage IIIC under the new FIGO 2018 staging system, and radical chemoradiotherapy was recommended. But heterogeneity in outcome existed in this group of patients. We conducted this retrospective analysis to evaluate the heterogeneity of these patients and tried to provide a more detailed classification to reflect the prognosis and guide the treatment. We also evaluated the efficacy and toxicity of surgery followed by sequential chemoradiotherapy in this cohort.MethodsEarly-stage cervical cancer with LN involvement that had radical hysterectomy followed by sequential chemoradiotherapy were retrospectively analyzed. Survival analyses were conducted to identify the prognostic factors.ResultsA total of 242 patients were included in the study; 64 (26.4%) patients had treatment failure, and 51 (21.1%) died. Pathology, T stage, the number of pathologic LN (pLN), and neoadjuvant chemotherapy or not were independent prognostic factors for disease-free survival and overall survival (OS). Patients with T1N < 3 pLN had significantly better survival than T2N < 3 pLN/T1-2 N≥ 3 pLN, with failure rates of 11.6% and 35.8% in each group; and 5 year OS was 92% and 62%, respectively (P = 0.000). About 1.5% of the patients discontinued radiotherapy, and 14.1% had G3-4 hematological toxic effects during radiotherapy; 1.7% developed G2-3 lower limb edema, and 2.9% developed severe urinary toxicity.ConclusionNodal involvement alone is inadequate as the sole pathologic factor to predict survival in early-stage cervical cancer. The combination of tumor and node subcategory provides better prognostic discrimination.

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“…Sedlis criteria6 represent the most commonly used risk stratification criteria, which are also linked to therapeutic decisions regarding the use of adjuvant radiation. Sedlis criteria developed in patients with squamous carcinoma are designed to select patients with squamous carcinoma who have ≥30% risk of local recurrence 27. The criteria do not specifically address the risk of relapse in adenocarcinoma patients.…”

Section: Risk Stratification In the Postoperative Cohortmentioning

confidence: 99%

“…The broader compartmentalization of patients into 'intermediate risk' within Sedlis criteria does not allow discrimination of either disease free survival or overall survival based on individual risk factors. More recently, risk factors for patients treated with surgery in GOG 49,92, and 141 studies were reviewed to refine patient selection for adjuvant treatment 27. The combined analysis of these trials (n=820 patients; 715 with squamous carcinoma and 105 with adenocarcinoma) suggested that the Sedlis criteria may exclude many patients at high risk of relapse, and a histology specific nomogram should be utilized 6 27…”

Section: Risk Stratification In the Postoperative Cohortmentioning

confidence: 99%

“…More recently, risk factors for patients treated with surgery in GOG 49,92, and 141 studies were reviewed to refine patient selection for adjuvant treatment 27. The combined analysis of these trials (n=820 patients; 715 with squamous carcinoma and 105 with adenocarcinoma) suggested that the Sedlis criteria may exclude many patients at high risk of relapse, and a histology specific nomogram should be utilized 6 27…”

Section: Risk Stratification In the Postoperative Cohortmentioning

confidence: 99%

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Postoperative adjuvant radiation for cervix cancer: reflections on the evidence and a peep into the future

Chopra

Ranjan

Mittal

2022

Int J Gynecol Cancer

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Early stage cervical cancer, stages IB1–2 and IIA1, can be treated with (chemo)radiation and brachytherapy or radical hysterectomy with or without further adjuvant (chemo)radiation. In a carefully selected cohort for surgery, traditionally a small proportion of patients would need adjuvant (chemo)radiation so that the therapeutic ratio is maximized. However, advances in radiation technology, specifically intensity modulated radiotherapy, have led to a reduction in treatment related adverse events. Also, recent developments in risk stratification suggest using a lower threshold to offer adjuvant treatment to minimize pelvic relapse. These developments together present opportunities of not only re-examining the therapeutic ratio but also of further evolving postoperative risk stratification. This review article summarizes the current evidence on adjuvant treatment strategies and summarizes the key areas where research should be focused.

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Beyond Sedlis—A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis

Cited by 33 publications

References 16 publications

Development and Validation of a Prediction Model for Predicting the Prognosis of Postoperative Patients with Hepatocellular Carcinoma

Development and Validation of a Prediction Model for Predicting the Prognosis of Postoperative Patients with Hepatocellular Carcinoma

The Combination of T Stage and the Number of Pathologic Lymph Nodes Provides Better Prognostic Discrimination in Early-Stage Cervical Cancer With Lymph Node Involvement

Postoperative adjuvant radiation for cervix cancer: reflections on the evidence and a peep into the future

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