Development and Validation of a Nomogram for the Estimation of Response to Platinum-Based Neoadjuvant Chemotherapy in Patients with Locally Advanced Cervical Cancer

Wei Chen; Bo Wang; Rong Zeng; Tiejun Wang

doi:10.2147/CMAR.S293268

Development and Validation of a Nomogram for the Estimation of Response to Platinum-Based Neoadjuvant Chemotherapy in Patients with Locally Advanced Cervical Cancer

Cancer Manag Res. 2021 Feb 11:13:1279-1289. doi: 10.2147/CMAR.S293268. eCollection 2021.

Authors

Wei Chen¹, Bo Wang², Rong Zeng³, Tiejun Wang¹

Affiliations

¹ Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology and Hubei Provincial Clinical Research Center for Breast Cancer, Wuhan, Hubei, 430079, People's Republic of China.
² Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
³ Department of Obstetrics and Gynecology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.

Abstract

Purpose: Non-response to platinum-based neoadjuvant chemotherapy (non-rNACT) reduces the surgical outcomes of patients with locally advanced cervical cancer (LACC). The development of an accurate preoperative method to predict a patient's response to NACT (rNACT) could help surgeons to manage therapeutic intervention in a more appropriate manner.

Patients and methods: We recruited a total of 341 consecutive patients who underwent platinum-based NACT followed by radical surgery (RS) at the Hubei Cancer Hospital between January 1, 2010 and April 1, 2020. All patients had been diagnosed with stage Ib2-IIa2 cervical cancer in accordance with the 2009 International Federation of Gynecology and Obstetrics (FIGO) classification system. First, we created a training cohort of patients who underwent NACT+RS (n=239) to develop a nomogram. We then validated the performance of the nomogram in a validation cohort of patients who underwent NACT+RS (n=102). Data analysis was conducted from October 1, 2020. First, we determined overall survival (OS) and progression-free survival (PFS) after NACT+RS. Multivariate logistic regression was then used to identify independent risk factors that were associated with the response to rNACT; these were then incorporated into the nomogram.

Results: The analysis identified several significant differences between the rNACT and non-rNACT groups, including neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphocyte monocyte ratio (LMR), platelet count, and FIGO stage. The performance of the rNACT nomogram score exhibited a robust C-index of 0.76 (95% confidence interval [CI]: 0.65 to 0.87) in the training cohort and high C-index of 0.71 (95% CI: 0.62 to 0.78) in the validation cohort. Clinical impact curves showed that the nomogram had good predictive ability.

Conclusion: We successfully established an accurate and optimized nomogram that could be used preoperatively to predict rNACT in patients with LACC. This model can be used to evaluate the risk of an individual patient experiencing rNACT and therefore facilitate the choice of treatment.

Keywords: clinical response; locally advanced cervical cancer; neoadjuvant chemotherapy; nomogram prediction; prognosis.

Grants and funding

This research was supported by the Natural Science Foundation of Hubei Province (No.2019CFB643).