Impact of the diagnosis-surgery interval on survival outcomes and development of a nomogram for predicting survival in early-stage cervical cancer: a Surveillance, Epidemiology, and End Results database analysis.

OBJECTIVE

We evaluated the association between the diagnosis-surgery interval on survival in early-stage cervical cancer (CC) and developed a nomogram for survival prediction.

METHODS

We analyzed Surveillance, Epidemiology, and End Results data (2000-2019) of 7,827 patients with stage I-II CC who underwent radical or extended hysterectomy as primary treatment. Associations among the diagnosis-surgery interval, prognostic factors, overall survival (OS), and cancer-specific survival (CSS) were examined. A nomogram constructed using a multivariate Cox model was assessed using the concordance index (C-index) and a calibration curve.

RESULTS

Most patients had stage I (95.15%) squamous cell carcinoma (62.21%), tumor size ≤2 cm (39.86%), without lymph node (LN) involvement (86.07%). Adjuvant radiation and chemotherapy were administered to 28.03% and 18.72% of the patients, respectively. The median diagnosis-surgery interval was 1 month (range: 0-17 months). Older age, non-Hispanic black race, higher stage, higher grade, larger tumor size, LN involvement, adjuvant radiation, and surgical delay (>1 month) were associated with worse OS and CSS (p=0.009 and p=0.022, respectively). Adenosquamous carcinoma was associated with poor CSS. The nomogram predicted survival, with areas under the curve of 76.07% and 80.19% for 5-year OS and CSS, respectively. Calibration curves and C-index values (0.735 for OS and 0.777 for CSS) confirmed the nomogram's accuracy in predicting 3-, 5-, and 10-year OS and CSS in early-stage CC.

CONCLUSION

Surgical delays of >1 month were associated with worse survival in early-stage CC. The developed nomogram incorporates multiple prognostic factors to enhance personalized risk assessment and survival prediction.