Nomogram predicts grade ≥2 acute radiation enteritis in cervical cancer patients

A nomogram model displays a decent performance in predicting grade ≥2 acute radiation enteritis (ARE) among patients with cervical cancer receiving concurrent chemoradiotherapy, a study has shown.

“The nomogram model for grade ≥2 ARE has good predictive ability and clinical utility, and is convenient for clinicians to identify high-risk groups and develop early prevention and treatment strategies,” said the researchers led by Dr Fei Chen, Department of Radiation Oncology Center, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.

Factors independently predictive of grade ≥2 ARE included malnutrition, monocyte-lymphocyte ratio (MLR) ≥0.82 after radiotherapy, platelet-lymphocyte ratio (PLR) <307.50 after radiotherapy, and bowelbag volume receiving at least 5 and 40 Gy. These risk factors were then incorporated into the nomogram (p<0.05). [Am J Clin Oncol 2024;47:317-324]

The nomogram showed good discrimination based on the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), as well as net benefit in the clinical setting.

Moreover, the cutoff point used was a medium nomogram score of 146.50 points. The high-score group had a higher incidence of grade ≥2 ARE than the low-score group (p<0.05).

“The nomogram prediction model based on these results has good predictive performance and clinical utility, which can provide a reference for the prevention of grade ≥2 ARE,” said Chen. “[H]owever, prospective studies with large samples and multiple centres are still needed to further verify our results.”

In earlier studies, the incidence of ARE in patients with cervical cancer undergoing radiotherapy was 54‒75 percent, while the incidence of grade ≥2 ARE was 22‒45 percent. These findings were “roughly similar to our results,” according to Chen. [J Cancer Res Ther 2018;14:S120–S124; BMC Cancer 2023;23:481; Front Oncol 2022;12:1021453]

Inflammatory response

Neutrophil-lymphocyte ratio, MLR, and PLR are simple indices of systemic inflammatory response that can be used to predict intestinal problems, such as Crohn’s disease, ulcerative colitis, and acute intestinal obstruction. [J Clin Med 2021;10:4219; Int Immunopharmacol 2021;101:108235; ANZ J Surg 2022;92:2915-2920]

The current study found that MLR ≥0.82 or PLR <307.50 after radiotherapy correlated with a higher incidence of grade ≥2 ARE.

“These inflammatory indices are routinely used in clinical practice and can be obtained early in the course of radiotherapy by blood routine examination, which are of great significance for the early prediction of the occurrence and severity of ARE in clinical practice,” Chen said.

This study retrospectively enrolled 273 patients with cervical cancer on concurrent chemoradiotherapy, who were then divided into training and validation groups. Chen and colleagues analysed clinical parameters using univariate analysis and multivariate logistic regression analysis.

The researchers created a nomogram model based on independent risk factors selected using multivariate logistic regression. The ROC curve, calibration curve, and DCA were used to assess the nomogram. Patients were then categorized into high- and low-score groups.

“The nomogram model can graphically and visually visualize the results of the multivariate logistic regression analysis,” Chen said. “Therefore, establishing an intuitive, simple, and effective nomogram model can guide clinicians to prevent and treat acute radiation enteritis.”