Predicting survival and risk stratification based on nomogram for locally advanced cervical cancer patients of the 2018 FIGO staging system treated with radiochemotherapy in southern China: a retrospective study

Background: Concurrent chemoradiation has been the standard treatment for locally advanced cervical cancer patients worldwide. This study was conducted to construct the nomogram of prognosis and risk stratification for locally advanced cervical cancer in southern ChinaMaterial and Methods: The medical records of 258 LACC patients who mostly received cisplatin-based concurrent chemoradiation and high-dose-rate intracavity brachytherapy at the first affiliated hospital of Guangxi Medical University were analyzed. Stepwise selection of 22 factors with the Elastic net method was used to obtain a predictive model and construct nomograms for both progression-free survival (PFS) and overall survival (OS).Results: The median follow-up period was 47 months. The 3-year and 5-year OS were 73.7% and 65.9%, respectively, while the 3-year and 5-year PFS were 68.1% and 60.2%. In the multivariable analysis, different cumulative cisplatin dose (<180mg/m2: HR: 0.099, 95% CI: 0.010–0.909, p=0.040; 180-200mg/m2: HR: 0.058, 95% CI: 0.006-0.545, p=0.012; >200mg/m2: HR: 0.050, 95% CI: 0.006–0.520, p=0.012), bulky tumors (HR: 1.869, 95% CI: 1.127–3.098, p=0.015), ICBT (HR: 0.385, 95% CI: 0.218–0.681, p=0.001), and thrombocytopenia pre-treatment (HR: 6.832, 95% CI: 1.169–39.902, p=0.032) had significant effect on PFS, and OS was influenced by bulky tumors (HR: 1.916, 95% CI: 1.100–3.336, p=0.021), ICBT (HR: 0.499, 95% CI: 0.252-0.986, p=0.045), thrombocytopenia pre-treatment (HR: 3.865, 95% CI: 1.367-10.922, p=0.010) and high neutrophilic granulocyte percentage level in early stages of the treatment (HR: 2.041, 95% CI: 1.172–3.552, p=0.011).Nomograms of the independent predictors were established (cross-validated concordance probability c=0.671 for PFS, and 0.673 for OS). Based on the scores of the nomogram, subgroups of risk stratification further constructed showed a statistically difference in survival (p<0.05).Conclusions: Our study shows the prognostic value of nomogram to predict survival and establish risk stratification for LACC patients from southern China. Future individualized tailoring of therapy should focus even further on the high-risk patient populations.