医学
宫颈癌
阶段(地层学)
淋巴结
淋巴血管侵犯
癌症登记处
优势比
癌症
肿瘤科
内科学
妇科
人口
腺癌
产科
转移
古生物学
环境卫生
生物
作者
Hans H B Wenzel,Anna Norberg Hardie,Arturo Moncada‐Torres,Claus Høgdall,Ruud L.M. Bekkers,Henrik Falconer,Pernille Tine Jensen,Hans W. Nijman,Maaike A. van der Aa,Frank Martin,Anna J. van Gestel,Valery Lemmens,Pernilla Dahm‐Kähler,Emilia Alfonzo,Jan Persson,Linnea Ekdahl,Sahar Salehi,Ligita Paskeviciute Frøding,Algirdas Markauskas,Katrine Fuglsang,Tine Henrichsen Schnack
标识
DOI:10.1016/j.ejca.2023.02.021
摘要
Lymph node metastases (pN+) in presumed early-stage cervical cancer negatively impact prognosis. Using federated learning, we aimed to develop a tool to identify a group of women at low risk of pN+, to guide the shared decision-making process concerning the extent of lymph node dissection.Women with cervical cancer between 2005 and 2020 were identified retrospectively from population-based registries: the Danish Gynaecological Cancer Database, Swedish Quality Registry for Gynaecologic Cancer and Netherlands Cancer Registry. Inclusion criteria were: squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma; The International Federation of Gynecology and Obstetrics 2009 IA2, IB1 and IIA1; treatment with radical hysterectomy and pelvic lymph node assessment. We applied privacy-preserving federated logistic regression to identify risk factors of pN+. Significant factors were used to stratify the risk of pN+.We included 3606 women (pN+ 11%). The most important risk factors of pN+ were lymphovascular space invasion (LVSI) (odds ratio [OR] 5.16, 95% confidence interval [CI], 4.59-5.79), tumour size 21-40 mm (OR 2.14, 95% CI, 1.89-2.43) and depth of invasion>10 mm (OR 1.81, 95% CI, 1.59-2.08). A group of 1469 women (41%)-with tumours without LVSI, tumour size ≤20 mm, and depth of invasion ≤10 mm-had a very low risk of pN+ (2.4%, 95% CI, 1.7-3.3%).Early-stage cervical cancer without LVSI, a tumour size ≤20 mm and depth of invasion ≤10 mm, confers a low risk of pN+. Based on an international privacy-preserving analysis, we developed a useful tool to guide the shared decision-making process regarding lymph node dissection.
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