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

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al.compredictingtheprognosisofuterinecervicalcancer[6–10];threeof

thesehavebeendesignedbasedonpatientswhoreceivedcurative

RT[6,7,10],whiletheotherscamefrompatientswhohadreceived

RHalone[9]oranytypeoftreatment[8].Atpresent,nonomogram