DISCUSSION
Syphilis infection, tumor, cancer, syphilis, malignant tumor
TUMOR, METASTASIS, HPV INFECTION, CANCER, SYPHILIS, STD, LYMPH NODE METASTASIS, CONDYLOMA ACUMINATUM, MALIGNANT TUMOR, EVENTS, PATHOGENESIS
CC currently ranks the fourth most common cancer according to global statistics.A handful of prognostic factors have been proposed for CC, although consensus remains to be established for some, including pathological factors.In addition to pathological subtype, there is a large body of evidence supporting the prognostic significance of vascular invasion and PLN metastasis in CC.Additionally, a meta‐analysis of 25 studies with a total of 6500 patients suggested prognostic relevance for tumor size in addition to lymph node metastasis and vascular invasion.NCCN guidelines for CC also recommend parametrial involvement as a high risk factor after surgery, which was supported by a study of 110 early CC patients, which showed associated parametrial involvement with poor prognosis after surgical intervention.Prognostic significance of cervical myometrial invasion remains under debate.Notably, we also identified a novel potential poor prognosticator of DFS, i.e. malignant tumor history. This may be related to the decline in physical function caused by the patient's previous suffering from other cancer.Interestingly, a history of STD was negatively associated with OS in this study. Existing research mainly focuses on the history of STD and CC incidence instead of prognosis. Patients with a history of STD in this study mostly had syphilis, followed by condyloma acuminatum. Syphilis infection has been found necessary for the CC pathogenesis following HPV infection and proposed as a predictor of invasive CC.Nomograms are an established tool for estimating cancer prognosis in quantitative terms and has been adopted in CC.Performance evaluations of the nomogram model0.775 (95%CI:0.707–0.842);0.831 (95%CI:0.768–0.894)0.831 (95%CI:0.815–0.847);0.855 (95%CI:0.839–0.871)Our study established a nomogram for predicting DFS based on cervical myometrial invasion, parametrial invasion and malignant tumor history and one for predicting OS based on pathological type, cervical myometrial invasion and history of STD. As far as we know, we are the first study to link the history of malignant tumor and STD with poor prognosis in CC patients and establish nomograms. In addition, both models were evaluated with C‐index, ROC curve, Brier score, and DCA analysis, all of which indicated high performance and clinical applicability. C‐index for the two models were 0.775 (0.707–0.842) for DFS and 0.831 (0.768–0.894) for OS in the training set and 0.799 (0.711–0.888) for DFS and 0.839 (0.756–0.921) for OS in the validation set. Calibration curves of 3‐year and 5‐year were also created based on internal validation of bootstrap resampling and showed remarkable accuracy.Decision curve analysis (DCA) can calculate the net benefit of a predictive model to measure its clinical utility. DCA was performed to evaluate the clinical applicability of the constructed nomograms when quantifying the net improvement benefits under different threshold probabilities.Despite having achieved prognostic accuracy, our study is not devoid of limitations. In addition to the retrospective, single‐center nature, the nomogram models, which did not undergo validation with an external cohort. Secondly, the calibration curve suggested low performance in predicting 5‐year survival rates for OS and DFS chart is poor, which may be owing to the higher proportion of censored events at this time point.