Journal Article

Impacts of ovarian preservation on the prognosis of neuroendocrine cervical carcinoma: a retrospective analysis based on machine learning

Zhang, Yunqiang, Hua, Keqin, Xiang, Xuesong, Ding, Jingxin

2023

Overview

Background Neuroendocrine cervical carcinoma (NECC) is a rare but aggressive malignancy with younger patients compared to other common histology types. This study aimed to evaluate the impacts of ovarian preservation (OP) on the prognosis of NECC through machine learning. Methods Between 2013 and 2021, 116 NECC patients with a median age of 46 years received OP or bilateral salpingo-oophorectomy (BSO) and were enrolled in a retrospective analysis with a median follow-up of 41 months. The prognosis was estimated using Kaplan–Meier analysis. Random forest, LASSO, stepwise, and optimum subset prognostic models were constructed in training cohort (randomly selected 70 patients) and tested in 46 patients through receiver operator curves. Risk factors for ovarian metastasis were identified through univariate and multivariate regression analyses. All data processing was carried out in R 4.2.0 software. Results Among 116 patients, 30 (25.9%) received OP and showed no significantly different OS compared with BSO group ( p  = 0.072) and got better DFS ( p  = 0.038). After construction of machine learning models, the safety of OP was validated in lower prognostic risk group ( p  > 0.05). In patients ≤ 46 years, no impacts of OP were shown for DFS ( p  = 0.58) or OS ( p  = 0.67), and OP had no impact on DFS in different relapse risk population ( p  > 0.05). In BSO group, regression analyses showed that later stage, para-aortic LNM, and parametrial involvement were associated with ovarian metastasis ( p  < 0.05). Conclusions Preserving ovaries had no significant impact on prognosis in patients with NECC. OP should be considered cautiously in patients with ovarian metastasis risk factors.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Aorta / Cancer therapies / Carcinoma, Neuroendocrine - pathology / Carcinoma, Neuroendocrine - surgery / Care and treatment / Cervical cancer / Cervical carcinoma / Data processing / Development and progression / Fallopian tubes / Female / Gynecology / Histology / Human papillomavirus / Humans / Hysterectomy / Learning algorithms / Machine learning / Malignancy / Medical prognosis / Medicine / Medicine & Public Health / Metastases / Metastasis / Methods / Middle Aged / Morphology / Multivariate analysis / Neoplasm Recurrence, Local - pathology / Neoplasm Staging / Neuroendocrine cervical carcinoma / Obstetrics / Ovarian metastasis / Ovarian Neoplasms - pathology / Ovarian preservation / Ovariectomy / Ovaries / Pathology / Patient outcomes / Preservation / Prevention / Prognosis / Radiation therapy / Radioisotope brachytherapy / Regression analysis / Retrospective Studies / Risk factors / Safety evaluation / Subgroup analysis / Surgery / Surgical Oncology / Uterine Cervical Neoplasms - pathology / Uterine Cervical Neoplasms - surgery / Womens health