IGCS 2012 Vancouver, BC, Canada

Benefits of nomogram versus staging in cervical cancer

Dr Stephen Polterauer – Medical University of Vienna, Austria

Stephen, you’re here to inject precision into cancer medicine, precision in the form of a nomogram because if you have a patient with cervical cancer it’s very helpful to have precise information. Can you tell me about your nomogram? You’ve worked this up and you think that we can now apply this with great benefit in treating patients with cervical cancer.

Yes, traditionally we use staging systems like the FIGO staging that is a clinical staging to estimate patients’ prognosis in cervical cancer. But the staging system accounts for some important parameters but not for all known prognostic parameters.

What are the big drawbacks of the staging system?

The staging system is a clinical staging and includes factors such as tumour size, extra-uterine spread or metastases but it does not account, for example, for lymph node status or for patients’ age or histology.

And with your nomogram you’re able to predict overall survival quite accurately, is that it?

That’s correct. We try to construct a nomogram that incorporates more than one clinical parameter in order to individualise the estimation of prognosis for patients with cervical cancer.

So what is your nomogram?

Our nomogram is a prediction model that incorporates six clinical parameters such as FIGO stage, age, histology, parametrial involvement, lymph node involvement and additionally parametrial involvement. It allows accurate and individualised prediction of patients’ outcome so we are able to predict patients’ three or five year overall survival rate by incorporating all those parameters and not only grouping patients into prognostic groups based on a single parameter. It makes it much more accurate than the traditional system.

Now you’ve done this, you’ve constructed this on all the available evidence, have you also validated it with real patients as you go along?

We used patient data for two large Austrian institutions to construct a nomogram and then we used an internal validation to validate our findings and make them more applicable. We also constructed an online calculator that can be accessed through our website where physicians can access and use this online prediction tool in order to estimate patients’ prognosis.

So what do doctors do with this now? Can you explain how to use it?

Each patient is allocated points for each parameter and you sum the points and you get a total score. The total score corresponds with a three or five year overall survival rate. We constructed an online prediction tool that makes it very convenient for physicians where you can enter the nomogram variables and the tool provides Kaplan-Meier curves and three and five year overall survival rates for each individual patient.

So can you then have nomogram guided therapy?

That’s a very good question. The therapy within our patient cohort was heterogeneous because the nomogram construction was based on retrospective data so we did not include the effect of treatment into the nomogram. But it can be used for patient counselling and it can also be used to guide follow-up strategies, let’s say for a patient with a high risk of cancer related death you would rather prefer to have close follow-up visits.

So at the moment you mainly recommend it, do you, to allow the clinician to know what’s actually happening, what’s likely to happen but could you extend this further to applying it in the future, do you think?

That’s correct. You’re not supposed to use it to base your decisions on treatment. If you would like to do that you would need to use a prospective cohort of patients and use the data to calculate the effect of therapy within this cohort.

So to sum up, what should the cancer doctor make of your nomogram at this moment and how should he or she use it?

It can be accessed online and physicians can use it in order to estimate patients’ prognosis in a more individualised way than based on FIGO stage alone. These informations can be used for patient counselling to let a patient know how her individual prognosis might be and it can also be used for guiding the follow-up strategies.

And it’s all in the interests of more accurately reviewing the patient data and looking ahead.

By using this nomogram, physicians can more accurately and more personalised estimate the risk of prognosis.

Stephen thank you for joining ecancer.tv today.

It was a pleasure, thank you.