Archives of Gynecology and Obstetrics

, Volume 298, Issue 2, pp 381–388 | Cite as

Nomogram for predicting para-aortic lymph node metastases in patients with cervical cancer

  • Weiping Wang
  • Xiaoliang Liu
  • Qingyu Meng
  • Fuquan ZhangEmail author
  • Ke HuEmail author
Gynecologic Oncology



Some patients with cervical cancer may benefit from prophylactic extended-field radiotherapy (EFRT). However, the indications for prophylactic EFRT were unclear. In this study, we constructed a nomogram to predict para-aortic lymph node (PALN) metastases in cervical cancer.


Between January 2011 and June 2017, 1903 patients with stage IA–IVA cervical cancer received definitive radiotherapy. Patients who were diagnosed during 2011–2015 were assigned to a model development cohort (n = 1193) and others were assigned to a validation cohort (n = 710). Possible predictors were analysed using logistic regression models with model development cohort. A nomogram based on this work was constructed and validated.


A total of 130 patients (6.8%) suffered from PALN metastases, with 81 patients (6.8%) in the model development cohort and 49 patients (6.9%) in the validation group. Multivariate analysis of the model development cohort demonstrated that histology, tumour size, bilateral pelvic lymph node (PLN) metastases, common iliac lymph node metastases and PLN convergence or muscle involvement were significant predictive factors of PALN metastases. The nomogram including these five factors showed good predictive accuracy (concordance index 0.916, 95% confidence interval, CI 0.881–0.952) in the model development cohort. In the validation cohort, the nomogram showed good discrimination (concordance index 0.949, 95% CI 0.911–0.988) and the predicted probability was close to the actual observed outcome.


We have developed a robust tool that is able to predict PALN metastases in patients with cervical cancer. The nomogram could help physicians to decide whether prophylactic EFRT should be performed for patients with cervical cancer patients.


Cervical cancer Nomogram Para-aortic lymph nodes metastases Extended-field radiotherapy 


Author contribution

WW: data collection and original writing. XL: data analysis and original writing. QM: data analysis. FZ: conceptualisation and writing review. KH: conceptualisation and writing review.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Wang YM, Wang CJ, Fang FM, Chen HC, Hsu HC, Huang YJ, Wang CY, Huang EY (2017) Differences in the outcomes and complications between elderly and younger uterine cervical cancer patients treated by definitive radiotherapy—a propensity score-matched study. Gynecol Oncol 145:277–283CrossRefPubMedGoogle Scholar
  2. 2.
    Kidd EA, Siegel BA, Dehdashti F, Rader JS, Mutic S, Mutch DG, Powell MA, Grigsby PW (2010) Clinical outcomes of definitive intensity-modulated radiation therapy with fluorodeoxyglucose-positron emission tomography simulation in patients with locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 77:1085–1091CrossRefPubMedGoogle Scholar
  3. 3.
    Han X, Wen H, Ju X, Chen X, Ke G, Zhou Y, Li J, Xia L et al (2017) Predictive factors of para-aortic lymph nodes metastasis in cervical cancer patients: a retrospective analysis based on 723 para-aortic lymphadenectomy cases. Oncotarget 8:51840–51847PubMedPubMedCentralGoogle Scholar
  4. 4.
    Shim SH, Kim DY, Lee SJ, Kim SN, Kang SB, Lee SW, Park JY, Suh DS et al (2017) Prediction model for para-aortic lymph node metastasis in patients with locally advanced cervical cancer. Gynecol Oncol 144:40–45CrossRefPubMedGoogle Scholar
  5. 5.
    Berman ML, Keys H, Creasman W, DiSaia P, Bundy B, Blessing J (1984) Survival and patterns of recurrence in cervical cancer metastatic to periaortic lymph nodes (a Gynecologic Oncology Group study). Gynecol Oncol 19:8–16CrossRefPubMedGoogle Scholar
  6. 6.
    Wang W, Hou X, Yan J, Shen J, Lian X, Sun S, Liu Z, Meng Q et al (2017) Outcome and toxicity of radical radiotherapy or concurrent chemoradiotherapy for elderly cervical cancer women. BMC Cancer 17:510CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Iasonos A, Schrag D, Raj GV, Panageas KS (2008) How to build and interpret a nomogram for cancer prognosis. J Clin Oncol 26:1364–1370CrossRefPubMedGoogle Scholar
  8. 8.
    Rotman M, Pajak TF, Choi K, Clery M, Marcial V, Grigsby PW, Cooper J, John M (1995) Prophylactic extended-field irradiation of para-aortic lymph nodes in stages IIB and bulky IB and IIA cervical carcinomas. Ten-year treatment results of RTOG 79-20. JAMA 274:387–393CrossRefPubMedGoogle Scholar
  9. 9.
    Liang JA, Chen SW, Hung YC, Yeh LS, Chang WC, Lin WC, Chang YY (2014) Low-dose, prophylactic, extended-field, intensity-modulated radiotherapy plus concurrent weekly cisplatin for patients with stage IB2-IIIB cervical cancer, positive pelvic lymph nodes, and negative para-aortic lymph nodes. Int J Gynecol Cancer 24:901–907CrossRefPubMedGoogle Scholar
  10. 10.
    Yap ML, Cuartero J, Yan J, Pintilie M, Fyles A, Levin W, Manchul L, Milosevic M (2014) The role of elective para-aortic lymph node irradiation in patients with locally advanced cervical cancer. Clin Oncol (R Coll Radiol) 26:797–803CrossRefGoogle Scholar
  11. 11.
    Park SG, Kim JH, Oh YK, Byun SJ, Kim MY, Kwon SH, Kim OB (2014) Is prophylactic irradiation to para-aortic lymph nodes in locally advanced cervical cancer necessary? Cancer Res Treat 46:374–382CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ring KL, Young JL, Dunlap NE, Andersen WA, Schneider BF (2009) Extended-field radiation therapy with whole pelvis radiotherapy and cisplatin chemosensitization in the treatment of IB2-IIIB cervical carcinoma: a retrospective review. Am J Obstet Gynecol 201(109):e101–e106Google Scholar
  13. 13.
    Roach M 3rd, DeSilvio M, Lawton C, Uhl V, Machtay M, Seider MJ, Rotman M, Jones C et al (2003) Phase III trial comparing whole-pelvic versus prostate-only radiotherapy and neoadjuvant versus adjuvant combined androgen suppression: radiation Therapy Oncology Group 9413. J Clin Oncol 21:1904–1911CrossRefPubMedGoogle Scholar
  14. 14.
    Choi HJ, Ju W, Myung SK, Kim Y (2010) Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: meta-analysis. Cancer Sci 101:1471–1479CrossRefPubMedGoogle Scholar
  15. 15.
    Liu B, Gao S, Li S (2017) A comprehensive comparison of CT, MRI, positron emission tomography or positron emission tomography/CT, and diffusion weighted imaging-MRI for detecting the lymph nodes metastases in patients with cervical cancer: a meta-analysis based on 67 studies. Gynecol Obstet Invest 82:209–222CrossRefPubMedGoogle Scholar
  16. 16.
    Shen G, Zhou H, Jia Z, Deng H (2015) Diagnostic performance of diffusion-weighted MRI for detection of pelvic metastatic lymph nodes in patients with cervical cancer: a systematic review and meta-analysis. Br J Radiol 88:20150063CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kang S, Kim SK, Chung DC, Seo SS, Kim JY, Nam BH, Park SY (2010) Diagnostic value of (18)F-FDG PET for evaluation of paraaortic nodal metastasis in patients with cervical carcinoma: a metaanalysis. J Nucl Med 51:360–367CrossRefPubMedGoogle Scholar
  18. 18.
    Brockbank E, Kokka F, Bryant A, Pomel C, Reynolds K (2013) Pre-treatment surgical para-aortic lymph node assessment in locally advanced cervical cancer. Cochrane Database Syst Rev. PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiation Oncology, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople’s Republic of China

Personalised recommendations