Markers of Prognosis for Early Stage Cervical Cancer Patients (Stage IB1, IB2) Undergoing Surgical Treatment

Chen Xu; Tie Ma; Hongzan Sun; Xiaohan Li; Song Gao

doi:10.3389/fonc.2021.659313

Markers of Prognosis for Early Stage Cervical Cancer Patients (Stage IB1, IB2) Undergoing Surgical Treatment

Front Oncol. 2021 Jun 2:11:659313. doi: 10.3389/fonc.2021.659313. eCollection 2021.

Authors

Chen Xu^{1

2}, Tie Ma³, Hongzan Sun^{1

2}, Xiaohan Li³, Song Gao⁴

Affiliations

¹ Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
² Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang, China.
³ Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China.
⁴ Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.

Abstract

Background: For individuals with cervical cancer, large tumor volume, lymph node metastasis, distant metastasis, and parauterine infiltration are usually associated with a poor prognosis. Individuals with stage 1B1 and 1B2 cervical cancer usually do not have these unfavorable prognostic factors. Once the disease progresses, the prognosis becomes extremely poor. Therefore, investigating the prognostic markers of these cervical cancer patients is necessary for treatment.

Methods: This retrospective study included 95 cervical cancer patients treated with surgery. The patients were divided into progressor and non-progressor groups according to postoperative follow-up results. T-test (or Mann-Whitney U test), chi-squared test (or Fisher's exact test) and receiver operating characteristic (ROC) curves were used to evaluate imaging, hematology, and clinicopathological index differences between the two groups. Cox analysis was performed to select the independent markers of progression-free survival (PFS) when developing the nomogram. Validation of the nomogram was performed with 1000 bootstrapped samples. The performance of the nomogram was validated with ROC curves, generated calibration curves, and Kaplan-Meier and decision curve analysis (DCA).

Results: Cervical stromal invasion depth, lymphovascular space invasion (LVSI), human papilloma virus (HPV-16), Glut1, D-dimer, SUVmax and SUVpeak showed significant differences between the two groups. Multivariate Cox proportional hazard model showed SUVpeak (p = 0.012), and HPV-16 (p = 0.007) were independent risk factors and were used to develop the nomogram for predicting PFS. The ROC curves, Kaplan-Meier method, calibration curves and DCA indicated satisfactory accuracy, agreement, and clinical usefulness, respectively.

Conclusions: SUVpeak level (≥7.63 g/cm3) and HPV-16 negative status before surgery were associated with worse PFS for patients with cervical cancer. Based on this result, we constructed the nomogram and showed satisfactory performance. Clinically, individualized clinical decision-making can be performed on patients based on this result.

Keywords: cervical cancer; computed tomography; human papilloma virus; positron-emission tomography; prognosis.