“Nomogram for predicting surgical modalities for initial treatment of
CINIII after menopause”
Abstract
Objective:Currently, there is no established preoperative
evaluation standard for direct hysterectomy in CINIII patients who are
unable to undergo conectomy.We have developed a nomogram that can be
used to predict surgical modalities for initial treatment of CINIII
after menopause,and estimated the performance of the nomogram by
internal validations. Design:Case-control design within
retrospective study. Setting:Shengjing Hospital of China
Medical University. Population or Sample:A total of 454
postmenopausal participants diagnosed with CINIII. Methods:
Group A and group B were divided into two cohorts based on different
initial treatment modalities. Group A underwent direct hysterectomy (88
cases), while group B underwent conization followed by hysterectomy (366
cases). Based on the postoperative pathological findings, the patients
were categorized into the upgraded pathological grope (105 cases, with 8
in group A and 97 in group B) and the non-upgraded pathological grope
(349 cases, with 80 in group A and 269 in group B).Multiple logistic
regression analysis was used to identify predictors and establish
nomogram.The performance of the nomogram was evaluated by using the area
under the curve (AUC),calibration curve and the decision curve
analysis(DCA). Main Outcome Measures:Pathological upgrade.
Result:The independent risk factors identified in this study
include menopause years,post-coital bleeding, HPV16/18
infection,cervical lesion counts, SCCAg and TCT (P<0.05). The
six indicators were used to create a nomogram for predicting
pathological upgrade. The training set yielded an AUC of 0.959 (95%
confidence interval [CI], 0.936-0.982), while the validation set
showed an AUC of 0.850 (95% CI, 0.775-0.926).The nomogram was
well-calibrated.The DCA results demonstrate a higher net gain value.
Conclusion:The nomogram model predicts postoperative cervical
cancer risk in postmenopausal CINIII patients based on menopause years,
HPV16/18 positivity, TCT results, SCCAg levels, cervical lesion counts,
and post-coital bleeding. In cases of low risk, direct hysterectomy may
be considered as initial treatment. Our scoring system offers safer and
more efficient treatment options for patients.