Nomograms predicting survival and patterns of failure in patients with cervical cancer treated with concurrent chemoradiotherapy: A special focus on lymph nodes metastases

OBJECTIVE: To construct nomograms predicting survival and patterns of failure in patients with cervical cancer treated with concurrent chemoradiotherapy (CCRT). METHODS: A total of 833 patients with cervical cancer treated with definitive radiotherapy or CCRT in our institute from January 2011 to December 2014 were included. Cox proportional hazard regression models were used in univariate and multivariate analysis. The following variables were included in the univariate analysis: histology, FIGO stage, lymph node metastases (para-aortic, pelvic, common iliac, binary pelvic, and binary common iliac LNMs), the number of pelvic metastatic lymph nodes (MLNs), and the diameter of pelvic MLNs. Nomograms predicting the 3- and 5-year overall survival (OS), disease-free survival (DFS), local control (LC) and distant metastasis-free (DMF) were constructed. The nomograms were internally validated with respect to discrimination and calibration. RESULTS: The median follow-up period was 36.4 months (range,1.0 to 76.2 months). After univariate and multivariate analysis, histology, FIGO stage, para-aortic LNM, pelvic LNM, number of MLNs and diameter of pelvic MLNs significantly predicted OS, DFS, LC or DMF. Nomograms predicting the 3- and 5-year OS, DFS, LC and DMF were constructed incorporating these significant variables. These nomograms showed good discrimination and calibration, with a concordance index of 0.73 for predicting OS, 0.71 for DFS, 0.73 for LC and 0.67 for DMF. CONCLUSION: We constructed nomograms predicting survival and patterns of failure with a special focus on regional LNM in patients with cervical cancer treated with concurrent chemoradiotherapy.