A oncology group study
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Cervicalcancer
Anomogrampredictingtherisksofdistantmetastasisfollowing
postoperativeradiotherapyforuterinecervicalcarcinoma:AKorean
radiationoncologygroupstudy(KROG
12-08)
HyoungUkJea,1,SeungbongHana,1,YoungSeokKima,⇑,Joo-HyunNama,HakJaeKimb,JaeWeonKimb,
WonParkc,Duk-SooBaec,JinHeeKimd,SoJinShind,JureeKime,Ki-HeonLeee,MeeSunYoonf,
SeokMoKimf,Ji-YoonKimg,WonSupYoonh,NakWooLeeh,JinHwaChoii,Sang-YoonParkj,
Joo-YoungKimj
aAsanMedicalCenter,UniversityofUlsan,CollegeofMedicine,Seoul;bSeoulNationalUniversityHospital;cSamsungMedicalCenter,SungkyunkwanUniversitySchollofMedicine,Seoul;dDongsanMedicalCenter,KeimyungUniversitySchoolofMedicine,Daegu;eCheilGeneralHospitalandWomen’sHealthcareCenter,KwandongUniversity,CollegeofMedicine,Seoul;fChonnamNationalUniversityHwasunHospital,ChonnamNationalUniversityMedicalSchool;gTheCatholicUniversityofKorea,CollegeofMedicine,Seoul;hKoreaUniversityAnsanHospital;iChung-AngUniversityHospital,Seoul;andjResearchInstituteandHospital,NationalCancerCenter,Goyang,RepublicofKorea
articleinfo
Articlehistory:Received10March2013Receivedinrevisedform24January2014Accepted9March2014Availableonline5June2014
Keywords:NomogramUterinecervicalcancerAdjuvantradiotherapyabstract
Purpose:Todevelopanomogrampredictingtherisksofdistantmetastasisfollowingpostoperativeadju-vantradiationtherapyforearlystagecervicalcancer.Materialsandmethods:Wereviewedthemedicalrecordsof1069patientsfromtenparticipatinginstitu-tions.Patientsweredividedintotwocohorts:atrainingset(n=748)andavalidationset(n=321).Thedemographic,clinical,andpathologicalvariableswereincludedintheunivariateCoxproportionalhaz-ardsanalysis.Clinicallyestablishedandstatisticallysignificantprognosticvariableswereutilizedtodevelopanomogram.Results:Themodelwasconstructedusingfourvariables:histologictype,pelviclymphnodeinvolvement,depthofstromalinvasion,andparametrialinvasion.Thismodeldemonstratedgoodcalibrationanddis-crimination,withaninternallyvalidatedconcordanceindexof0.71andanexternallyvalidatedc-indexof0.65.ComparedtoFIGOstaging,whichshowedabroadrangeintermsofdistantmetastasis,thedevel-opednomogramcanaccuratelypredictindividualizedrisksbasedonindividualriskfactors.Conclusions:Thedevisedmodeloffersasignificantlyaccuratelevelofpredictionanddiscrimination.Inclinicalpracticeitcouldbeusefulforcounselingpatientsandselectingthepatientgroupwhocouldben-efitfrommoreintensive/furtherchemotherapy,oncevalidatedinaprospectivepatientcohort.Ó2014ElsevierIrelandLtd.Allrightsreserved.RadiotherapyandOncology111(2014)437–441
Uterinecervicalcanceristhethirdmostcommonlydiagnosed
malignancyworldwide.Anditranksasthesixthmostprevalent
cancerinKoreanfemales,whileitsincidenceshowsadecreasing
trend[1,2].Radicalhysterectomy(RH)isoneofthestandardmeth-
odsoftreatmentforearlystagecervicalcancerandadjuvantradio-
therapy(RT)isneededincaseswithriskfactors.Ithasbeenproven
thatadjuvantchemoradiotherapy(CRT)canprolongoveralland
progression-freesurvivalinhighriskpatientswithpositivelymph
node(LN),positiveorclosesurgicalresectionmargins,andpara-
metrialinvasion[3].IthasalsobeenknownthatadjuvantRTsignificantlyreducestherecurrencerateinpatientswithtwoor
moreintermediateriskfactorssuchasdeepstromalinvasion,large
tumorsize,andlymphovascularspaceinvasion[4].Themajorpat-
ternoffailurefollowingadjuvantRTorCRTisdistantmetastasis
ratherthanlocalfailure[3].Itisalsoknownthatrecurrenceafter
RHhasadismalprognosis,witha5-yearsurvivalrateof10%,par-
ticularlyinpatientswithdistantmetastasis[5].Therefore,itisof
utmostimportancetopredictwhichpatientscouldbenefitfrom
additionalchemotherapy.
Anomogramisapredictivetoolshowingagraphicalrepresen-
tationofastatisticalpredictivemodelthatgeneratesacontinuous
probabilityofaclinicalevent,suchasrecurrenceordeath.Through
theuseofanomogram,moreaccurateandindividualizedpredic-
tionscanbemade.Therearealreadyseveralnomogramsavailable
aspredictiontoolsinavarietyofcancersincludingprostate,breast,
renalcellcarcinoma,andsarcoma.Therearefivenomogramsfor
http://dx.doi.org/10.1016/j.radonc.2014.03.0250167-8140/Ó2014ElsevierIrelandLtd.Allrights
reserved.⇑Correspondingauthor.Address:DepartmentofRadiationOncology,AsanMedicalCenter,UniversityofUlsan,CollegeofMedicine,88,Olympic-ro43-gil,Songpa-gu,Seoul138-736,RepublicofKorea.E-mailaddress:ysk@amc.seoul.kr(Y.S.Kim).1HUJandSHwerejointleadauthorsonthis
manuscript.RadiotherapyandOncology111(2014)437–441
ContentslistsavailableatScienceDirect
RadiotherapyandOncology
journalhomepage:www.thegreenjou
r
n
al.compredictingtheprognosisofuterinecervicalcancer[6–10];threeof
thesehavebeendesignedbasedonpatientswhoreceivedcurative
RT[6,7,10],whiletheotherscamefrompatientswhohadreceived
RHalone[9]oranytypeoftreatment[8].Atpresent,nonomogram