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Nomograms enhance survival estimates in cervical cancer


 

FROM JOURNAL OF CLINICAL ONCOLOGY

References

Researchers have developed nomograms based on a variety of newly identified prognostic factors – tools that can enhance clinicians’ estimates of 2-year progression-free survival, 5-year overall survival, and pelvic recurrence for locally advanced cervical cancer, according to a report published online March 3 in Journal of Clinical Oncology.

Nomograms are graphic tools that allow rapid, simple calculation of a complex formula – in this case, survival odds and recurrence rates – based on the user’s input of relatively few data points. To develop the nomograms in this study, investigators first analyzed data from six multicenter Gynecologic Oncology Group clinical trials involving 2,042 patients with locally advanced cervical cancer. Most of these participants (65%) were treated with standard cisplatin-based chemoradiotherapy, and the remainder received either radiotherapy alone or a noncisplatin regimen, said Dr. Peter G. Rose of the Cleveland Clinic Foundation, and his associates.

They assessed numerous clinicopathologic and demographic factors to determine which ones were most useful for predicting survival and pelvic recurrence. Previous survival estimates for cervical cancer have been based primarily on disease stage, and, as expected, Dr. Rose and his colleagues found that disease stage, tumor size, pelvic node status, and performance status were significantly associated with progression-free and overall survival. But disease stage accounted for only 60% of the prognostic information in these study participants; the researchers discovered that tumor histology, patient race/ethnicity, tumor grade, and type of treatment also were significant predictors of survival.

They then used this information to devise the nomograms and to then validate their accuracy. The nomograms can now be used to more accurately estimate patient survival and disease recurrence, both in individual patients and in study populations, Dr. Rose and his associates said (J. Clin. Oncol. 2015 March 3 [doi:10.1200/JCO.2014.57.7122]). One limitation of basing the nomograms on clinical trial participants is that such patients tend to have better performance status, to be more motivated to treat their cancer aggressively, and to be more compliant with treatment than is the general population of patients encountered in real-world clinical practice, the investigators added.

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