Prognostic models for locally advanced cervical cancer: external validation of the published models

Abstract

ObjectiveTo externally validate the prognostic models for predicting the time-dependent outcome in patients with locally advanced cervical cancer (LACC) who were treated with concurrent chemoradiotherapy in an independent cohort.MethodsA historical cohort of 297 women with LACC who were treated with radical concurrent chemoradiotherapy from 1999 to 2014 at the 12 de Octubre University Hospital (H12O), Madrid, Spain. The external validity of prognostic models was quantified regarding discrimination, calibration, measures of overall performance, and decision curve analyses.ResultsThe review identified 8 studies containing 13 prognostic models. Different (International Federation of Gynecology and Obstetrics [FIGO] stages, parametrium involvement, hydronephrosis, location of positive nodes, and race) but related cohorts with validation cohort (5-year overall survival [OS]=70%; 5-year disease-free survival [DFS]=64%; average age of 50; and over 79% squamous cell) were evaluated. The following models exhibited good external validity in terms of discrimination and calibration but limited clinical utility: the OS model at 3 year from Kidd et al.'s study (area under the receiver operating characteristic curve [AUROC]=0.69; threshold of clinical utility [TCU] between 36% and 50%), the models of DFS at 1 year from Kidd et al.'s study (AUROC=0.64; TCU between 24% and 32%) and 2 years from Rose et al.'s study (AUROC=0.70; TCU between 19% and 58%) and the distant recurrence model at 5 years from Kang et al.'s study (AUROC=0.67; TCU between 12% and 36%).ConclusionThe external validation revealed the statistical and clinical usefulness of 4 prognostic models published in the literature.

Prognosis-Predicting Model Based on [18F]fluorodeoxyglucose PET Metabolic Parameters in Locally Advanced Cervical Cancer Patients Treated with Concurrent Chemoradiotherapy: Multi-Center Retrospective Study

“…Several prognostic models have been developed to predict mortality, cause-specific mortality, disease recurrence, and distant or paraaortic recurrence over a specific duration in patients diagnosed with locally advanced cervical cancer treated with CCRT [14][15][16][17][18][19]23]. Various types of prognostic factors-such as age, race, FIGO stage, histological type, degree of differentiation, lymph node involvement and location, tumor volume, SUVmax of cervical tumor, serum SCC antigen levels, and treatment received-have been used as components of the prognostic predictive models [24]. In our study, age, FIGO stage, tumor size, serum SCC antigen levels, pSUVmax, nSUVmax, and HPV status were the included prognostic factors for predicting 2-year DFS and 5-year OS.…”

[18F]FDG-PET/CT-based risk stratification in women with locally advanced uterine cervical cancer

“…Lora et al previously externally validated the Kidd prediction model [ 29 ] and concluded that the 3-year OS and the 1-year DSS are statistically valid with an AUC of 0.69 and 0.64 respectively. Although the observed survival of the patient cohort of Lora et al was similar to ours, the prediction model performed better in our cohort.…”

The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse

“…Positive lymph nodes have been shown to be the most important prognostic factor for distant relapses in locally advanced cervical cancer [ 18 – 20 ]. We found a three times higher risk of distant relapse for patients with positive lymph nodes.…”