Factors Used for Prognosis in Advanced Cervical Cancer

A new study yielded nomograms for the assessment of locally advanced cervical cancer. These tools included prognostic factors such as histology, performance status, and others.

The National Comprehensive Cancer Network’s guidelines currently include chemoradiotherapy as the standard for treatment of locally advanced cervical cancer. “The current Gynecologic Oncology Group [GOG] ancillary data study was undertaken to evaluate prognostic factors for locally advanced cervical cancer treated in the era of cisplatin-based chemoradiotherapy,” wrote study authors led by Peter G. Rose, MD, of the Cleveland Clinic Foundation.

The researchers retrospectively reviewed 2,042 patients with locally advanced cervical carcinoma who were enrolled in GOG clinical trials of concurrent cisplatin-based chemotherapy and radiotherapy. Nomograms were created for 2-year progression-free survival (PFS), 5-year overall survival (OS), and pelvic recurrence. Results were published online ahead of print on March 2 in the Journal of Clinical Oncology.

The nomograms assigned points for a variety of factors, and then correlated the total points to predicted probability of the outcome. These factors included: histology, race/ethnicity, performance status, tumor size, FIGO stage, grade, pelvic nodes, and specifics of treatment received. The race/ethnicity factor was significant for both 2-year PFS and 5-year OS largely because poorer outcomes among African American patients, and improved OS among Asians.

The 2-year PFS nomogram had a bootstrap-corrected concordance index of 0.62, and the 5-year OS nomogram had a concordance index of 0.64; authors noted that both were well calibrated.

The researchers also removed several non-significant factors and created a nomogram for pelvic recurrence. The bootstrap-corrected concordance index for this nomogram was 0.73 and was again well calibrated.

“Accurate estimation of survival for patients receiving a cancer diagnosis based on patient and tumor characteristics permits critical stratification in clinical trials and offers the possibility of tailoring the aggressiveness of treatment to the individual situation,” the authors wrote. Previous reports of survival in cervical cancer have relied solely on disease stage, but in this cohort, stage alone accounted for only about 60% of the prognostic information, with the rest coming from the other factors studied.

Cohort Details

The majority of patients in the cohort had squamous cell carcinoma (88.7%). Most also had a performance status of 0 (72.1%), and 60.8% of the total group were white. Most people did receive cisplatin-based chemoradiotherapy (65%).