Nomograms Predicting Progression-Free Survival, Overall Survival, and Pelvic Recurrence in Locally Advanced Cervical Cancer Developed From an Analysis of Identifiable Prognostic Factors in Patients From NRG Oncology/Gynecologic Oncology Group Randomized Trials of Chemoradiotherapy.
OBJECTIVE
To evaluate the prognostic factors in locally advanced cervical cancer limited to the pelvis and develop nomograms for 2-year progression-free survival (PFS), 5-year overall survival (OS), and pelvic recurrence.


METHODS
We retrospectively reviewed 2,042 patients with locally advanced cervical carcinoma enrolled onto Gynecologic Oncology Group clinical trials of concurrent cisplatin-based chemotherapy and radiotherapy. Nomograms for 2-year PFS, five-year OS, and pelvic recurrence were created as visualizations of Cox proportional hazards regression models. The models were validated by bootstrap-corrected, relatively unbiased estimates of discrimination and calibration.


RESULTS
Multivariable analysis identified prognostic factors including histology, race/ethnicity, performance status, tumor size, International Federation of Gynecology and Obstetrics stage, tumor grade, pelvic node status, and treatment with concurrent cisplatin-based chemotherapy. PFS, OS, and pelvic recurrence nomograms had bootstrap-corrected concordance indices of 0.62, 0.64, and 0.73, respectively, and were well calibrated.


CONCLUSIONS
Prognostic factors were used to develop nomograms for 2-year PFS, 5-year OS, and pelvic recurrence for locally advanced cervical cancer clinically limited to the pelvis treated with concurrent cisplatin-based chemotherapy and radiotherapy. These nomograms can be used to better estimate individual and collective outcomes.
Peter G. Rose, Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH; James Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Charles W. Whitney, Christiana Gynecologic Oncology, Apex Medical Center, Newark, DE; Frederick B. Stehman, Mel and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Rachelle Lanciano, Delaware County Regional Cancer Center, Drexel Hill, PA; Gillian M. Thomas, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; and Paul A. DiSilvestro, Women and Infants Hospital, Brown University, Providence, RI. rosep@ccf.org.
Peter G
PG
Rose
Peter G. Rose, Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH; James Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Charles W. Whitney, Christiana Gynecologic Oncology, Apex Medical Center, Newark, DE; Frederick B. Stehman, Mel and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Rachelle Lanciano, Delaware County Regional Cancer Center, Drexel Hill, PA; Gillian M. Thomas, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; and Paul A. DiSilvestro, Women and Infants Hospital, Brown University, Providence, RI.
James
J
Java
Peter G. Rose, Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH; James Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Charles W. Whitney, Christiana Gynecologic Oncology, Apex Medical Center, Newark, DE; Frederick B. Stehman, Mel and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Rachelle Lanciano, Delaware County Regional Cancer Center, Drexel Hill, PA; Gillian M. Thomas, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; and Paul A. DiSilvestro, Women and Infants Hospital, Brown University, Providence, RI.
Charles W
CW
Whitney
Peter G. Rose, Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH; James Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Charles W. Whitney, Christiana Gynecologic Oncology, Apex Medical Center, Newark, DE; Frederick B. Stehman, Mel and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Rachelle Lanciano, Delaware County Regional Cancer Center, Drexel Hill, PA; Gillian M. Thomas, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; and Paul A. DiSilvestro, Women and Infants Hospital, Brown University, Providence, RI.
Frederick B
FB
Stehman
Peter G. Rose, Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH; James Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Charles W. Whitney, Christiana Gynecologic Oncology, Apex Medical Center, Newark, DE; Frederick B. Stehman, Mel and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Rachelle Lanciano, Delaware County Regional Cancer Center, Drexel Hill, PA; Gillian M. Thomas, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; and Paul A. DiSilvestro, Women and Infants Hospital, Brown University, Providence, RI.
Rachelle
R
Lanciano
Peter G. Rose, Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH; James Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Charles W. Whitney, Christiana Gynecologic Oncology, Apex Medical Center, Newark, DE; Frederick B. Stehman, Mel and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Rachelle Lanciano, Delaware County Regional Cancer Center, Drexel Hill, PA; Gillian M. Thomas, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; and Paul A. DiSilvestro, Women and Infants Hospital, Brown University, Providence, RI.
Gillian M
GM
Thomas
Peter G. Rose, Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH; James Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Charles W. Whitney, Christiana Gynecologic Oncology, Apex Medical Center, Newark, DE; Frederick B. Stehman, Mel and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Rachelle Lanciano, Delaware County Regional Cancer Center, Drexel Hill, PA; Gillian M. Thomas, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; and Paul A. DiSilvestro, Women and Infants Hospital, Brown University, Providence, RI.
Paul A
PA
DiSilvestro
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D049451:Nomograms; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy*
D000970:Antineoplastic Agents; D002945:Cisplatin