title: A nomogram predicting the risks of distant metastasis following postoperative radiotherapy for uterine cervical carcinoma: a Korean radiation oncology group study (KROG 12-08).
abstract: OBJECTIVE
  To develop a nomogram predicting the risks of distant metastasis following postoperative adjuvant radiation therapy for early stage cervical cancer.
  
  
  METHODS
  We reviewed the medical records of 1069 patients from ten participating institutions. Patients were divided into two cohorts: a training set (n=748) and a validation set (n=321). The demographic, clinical, and pathological variables were included in the univariate Cox proportional hazards analysis. Clinically established and statistically significant prognostic variables were utilized to develop a nomogram.
  
  
  RESULTS
  The model was constructed using four variables: histologic type, pelvic lymph node involvement, depth of stromal invasion, and parametrial invasion. This model demonstrated good calibration and discrimination, with an internally validated concordance index of 0.71 and an externally validated c-index of 0.65. Compared to FIGO staging, which showed a broad range in terms of distant metastasis, the developed nomogram can accurately predict individualized risks based on individual risk factors.
  
  
  CONCLUSIONS
  The devised model offers a significantly accurate level of prediction and discrimination. In clinical practice it could be useful for counseling patients and selecting the patient group who could benefit from more intensive/further chemotherapy, once validated in a prospective patient cohort.
authors.affiliation: Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyoung Uk
authors.initials: HU
authors.lastname: Je
authors.affiliation: Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea.
authors.forename: Seungbong
authors.initials: S
authors.lastname: Han
authors.affiliation: Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea. Electronic address: ysk@amc.seoul.kr.
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea.
authors.forename: Joo-Hyun
authors.initials: JH
authors.lastname: Nam
authors.affiliation: Seoul National University Hospital, Republic of Korea.
authors.forename: Hak Jae
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Seoul National University Hospital, Republic of Korea.
authors.forename: Jae Weon
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Samsung Medical Center, Sungkyunkwan University Scholl of Medicine, Seoul, Republic of Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Park
authors.affiliation: Samsung Medical Center, Sungkyunkwan University Scholl of Medicine, Seoul, Republic of Korea.
authors.forename: Duk-Soo
authors.initials: DS
authors.lastname: Bae
authors.affiliation: Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
authors.forename: So Jin
authors.initials: SJ
authors.lastname: Shin
authors.affiliation: Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Republic of Korea.
authors.forename: Juree
authors.initials: J
authors.lastname: Kim
authors.affiliation: Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Republic of Korea.
authors.forename: Ki-Heon
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Republic of Korea.
authors.forename: Mee Sun
authors.initials: MS
authors.lastname: Yoon
authors.affiliation: Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Republic of Korea.
authors.forename: Seok Mo
authors.initials: SM
authors.lastname: Kim
authors.affiliation: The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea.
authors.forename: Ji-Yoon
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Korea University Ansan Hospital, Republic of Korea.
authors.forename: Won Sup
authors.initials: WS
authors.lastname: Yoon
authors.affiliation: Korea University Ansan Hospital, Republic of Korea.
authors.forename: Nak Woo
authors.initials: NW
authors.lastname: Lee
authors.affiliation: Chung-Ang University Hospital, Seoul, Republic of Korea.
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Sang-Yoon
authors.initials: SY
authors.lastname: Park
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D049451:Nomograms; D010388:Pelvis / Q000473:pathology; D011184:Postoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D055815:Young Adult
keywords: Adjuvant radiotherapy; Nomogram; Uterine cervical cancer