Risk Factor Analysis and Prediction of Para-Aortic Lymph Node Metastases in Locally Advanced Cervical Cancer

IF 2.9 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2024-12-16 DOI:10.1002/cam4.70492

Tinglu Wang, Jinchen Wei, Li Jiang, Lulu Huang, Tingting Huang, Shanshan Ma, Qiufeng Huang, Yong Zhang, Fang Wu

{"title":"Risk Factor Analysis and Prediction of Para-Aortic Lymph Node Metastases in Locally Advanced Cervical Cancer","authors":"Tinglu Wang, Jinchen Wei, Li Jiang, Lulu Huang, Tingting Huang, Shanshan Ma, Qiufeng Huang, Yong Zhang, Fang Wu","doi":"10.1002/cam4.70492","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Purpose</h3>\n \n <p>The indications of prophylactic extended-field radiotherapy (EFRT) remain uncertain. This study aims to identify the risk factors for para-aortic lymph node (PALN) metastases in locally advanced cervical cancer (LACC) and determine which part of patients may benefit from prophylactic EFRT.</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>Between January 2015 and July 2023, a single-center retrospective analysis was performed on patients with stages IB3 and IIA2-IVA cervical cancer. Lymph node involvement was assessed using positron emission tomography/computed tomography (PET/CT). Risk factors were evaluated by logistic regression. A prediction nomogram model was developed and validated.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 329 patients, 64 (19.5%) had PALN metastases. Univariate analysis indicated that tumor size > 5.3 cm, tumor maximum standardized uptake value (SUVmax) > 9.8, bilateral pelvic lymph node (PLN) metastases, the number of positive PLNs ≥ 3, and T3–T4 stages were related to PALN metastases. After multivariate logistic analysis, it was found that tumor size > 5.3 cm (odds ratio [OR] = 3.129, 95% confidence interval [CI] = 1.536–6.374, <i>p</i> = 0.002), and the number of positive PLNs ≥ 3 (OR = 11.260, 95% CI = 3.506–36.158, <i>p</i> < 0.001) were independent risk factors. The C-index of the nomogram was 0.886 (95% CI = 0.844–0.927). The calibration plot showed that the nomogram was well-fitted. Decision curve analysis (DCA) exhibited excellent clinical utility.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Tumor size > 5.3 cm and the number of positive PLNs ≥ 3 are independent risk factors of PALN metastases. The nomogram shows pretty good accuracy, which may provide a valuable reference for guiding patients who are very likely to develop PALN metastases to receive prophylactic EFRT.</p>\n </section>\n </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"13 24","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70492","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/cam4.70492","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Purpose

The indications of prophylactic extended-field radiotherapy (EFRT) remain uncertain. This study aims to identify the risk factors for para-aortic lymph node (PALN) metastases in locally advanced cervical cancer (LACC) and determine which part of patients may benefit from prophylactic EFRT.

Materials and Methods

Between January 2015 and July 2023, a single-center retrospective analysis was performed on patients with stages IB3 and IIA2-IVA cervical cancer. Lymph node involvement was assessed using positron emission tomography/computed tomography (PET/CT). Risk factors were evaluated by logistic regression. A prediction nomogram model was developed and validated.

Results

Among 329 patients, 64 (19.5%) had PALN metastases. Univariate analysis indicated that tumor size > 5.3 cm, tumor maximum standardized uptake value (SUVmax) > 9.8, bilateral pelvic lymph node (PLN) metastases, the number of positive PLNs ≥ 3, and T3–T4 stages were related to PALN metastases. After multivariate logistic analysis, it was found that tumor size > 5.3 cm (odds ratio [OR] = 3.129, 95% confidence interval [CI] = 1.536–6.374, p = 0.002), and the number of positive PLNs ≥ 3 (OR = 11.260, 95% CI = 3.506–36.158, p < 0.001) were independent risk factors. The C-index of the nomogram was 0.886 (95% CI = 0.844–0.927). The calibration plot showed that the nomogram was well-fitted. Decision curve analysis (DCA) exhibited excellent clinical utility.

Conclusion

Tumor size > 5.3 cm and the number of positive PLNs ≥ 3 are independent risk factors of PALN metastases. The nomogram shows pretty good accuracy, which may provide a valuable reference for guiding patients who are very likely to develop PALN metastases to receive prophylactic EFRT.

Abstract Image

查看原文本刊更多论文

局部晚期宫颈癌主动脉旁淋巴结转移的危险因素分析与预测

背景和目的：预防性扩大野放射治疗（EFRT）的适应症仍不确定。本研究旨在确定局部晚期宫颈癌（LACC）主动脉旁淋巴结（PALN）转移的风险因素，并确定哪一部分患者可能从预防性 EFRT 中获益：2015年1月至2023年7月期间，对IB3期和IIA2-IVA期宫颈癌患者进行了单中心回顾性分析。使用正电子发射断层扫描/计算机断层扫描（PET/CT）评估淋巴结受累情况。风险因素通过逻辑回归进行评估。结果：329名患者中，64人（19.5%）有PALN转移。单变量分析表明，肿瘤大小>5.3厘米、肿瘤最大标准化摄取值（SUVmax）>9.8、双侧盆腔淋巴结（PLN）转移、PLN阳性数目≥3以及T3-T4分期与PALN转移有关。经过多变量逻辑分析发现，肿瘤大小 > 5.3 cm（几率比 [OR] = 3.129，95% 置信区间 [CI] = 1.536-6.374，P = 0.002）和 PLN 阳性数≥ 3（OR = 11.260，95% CI = 3.506-36.158，P 结论：肿瘤大小 > 5.3 cm 和 PLN 阳性数≥ 3 与 PALN 转移有关：肿瘤大小 > 5.3 cm 和 PLN 阳性数≥ 3 是 PALN 转移的独立危险因素。该提名图显示出相当高的准确性，可为指导极有可能发生 PALN 转移的患者接受预防性 EFRT 提供有价值的参考。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.