Development and validation of a SEER-based prognostic nomogram for cervical cancer patients below the age of 45 years

Abstract

This study aimed to establish a nomogram for the prognostic prediction of patients with early-onset cervical cancer (EOCC) in both overall survival (OS) and cancer-specific survival (CSS). The 10,079 patients diagnosed with EOCC between 2004 and 2015 were captured within the Surveillance, Epidemiology, and End Results (SEER) database and further were divided into training and validation sets randomly. The independent prognostic factors were identified in a retrospective study of 7,055 patients training sets randomly. Besides, the prognostic nomogram was developed using R software according to multivariable Cox regression analysis. Furthermore, the model was externally validated using the data of 3,024 patients diagnosed at different times enrolled in the SEER database. In training set, the C-indexes for OS and CSS prediction were 0.831 (95% confidence interval [CI]: 0.815-0.847) and 0.855(95%CI:0.839-0.871). The results of ROC indicated that nomograms possessed better predict performance compared with TNM-stage and SEER-stage. And the areas under the curve (AUC) of the nomogram for OS and CSS prediction in ROC analysis were 0.855(95%CI:0.847-0.864) and 0.782(95%CI:0.760-0.804), respectively. In addition, calibration curves presented perfect agreements between the nomogram-predicted and actual 1-, 3-, and 5-year in the validation cohort, in OS rate and CSS rate. This study established and validated a prognostic nomogram that provided an accurate prediction of 3-, 5-, and 10-year OS and CSS of EOCC patients, which contributed to clinicians to be useful for patients’ counseling and clinical trial designing.