The Impact of Risk Factors for Cervical Squamous Cell Carcinoma on Patient Survival Rates at Varying Ratios of Cervical Wall Infiltration Depth 

The Impact of Risk Factors for Cervical Squamous Cell Carcinoma on Patient Survival Rates at Varying Ratios of Cervical Wall Infiltration Depth | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Impact of Risk Factors for Cervical Squamous Cell Carcinoma on Patient Survival Rates at Varying Ratios of Cervical Wall Infiltration Depth Qianni Yang, Xiaodong Han This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6309922/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Sep, 2025 Read the published version in BMC Cancer → Version 1 posted 10 You are reading this latest preprint version Abstract Objective: To investigate whether there are alterations in the influence of various risk factors on the prognosis of patients with cervical squamous cell carcinoma at different infiltration depths. Methods: A retrospective analysis was performed on 644 patients admitted to our hospital between July 2012 and March 2019. Based on postoperative pathological results, the first group (n=322) had cervical wall infiltration approaching nearly 100%, while the second group (n=322) had infiltration below 80%. Results: Univariate analysis revealed that the primary factors affecting patient prognosis in Group 1 were tumor volume(TV), vascular invasion(VI), and lymph node metastasis(LNM) (p<0.01), and maximum tumor diameter(MTD) (p=0.146); Group 2: TV, infiltration depth(ID), and LNM(p<0.05), VI (p=0.097). Multivariate analysis: In Group 1, TV and LNM were independent prognostic factors (p<0.05), whereas Group 2 had no independent prognostic factors. Conclusion: As infiltration depth increases, the impact of TV, LNM, and VI factors on the prognosis of patients with cervical squamous cell carcinoma significantly rises, with TV having a more pronounced effect on prognosis than tumor maximum diameter. cervical carcinoma prognostic factor vascular invasion lymph node metastasis radiotherapy Figures Figure 1 Figure 2 Introduction Cervical cancer is a prevalent form of cancer in developing countries, with surgical treatment and radiation therapy being the primary treatment methods. The intermediate risk factors for postoperative pathology of cervical cancer encompass whether the tumor's maximum diameter exceeds 4cm, the presence of cancer emboli in blood vessels, and whether the depth of invasion reaches one-third of the cervical thickness. High-risk factors include lymph node metastasis, parametrial invasion, and a positive vaginal stump [1] . For patients with cervical squamous cell carcinoma, the depth of infiltration is a significant risk factor for tumor recurrence, and this risk escalates with the presence of vascular cancer thrombus [2]. How do other risk factors influence the prognosis of cervical squamous cell carcinoma at varying depths of infiltration? Currently, there is a lack of research and reporting by scholars in this field. This article retrospectively analyzes patients with cervical squamous cell carcinoma who have undergone surgical treatment at our hospital, examining the impact of other risk factors on patient prognosis at different depths of infiltration. Materials and methods 1.1Case selection :A retrospective analysis was conducted on 644 patients with cervical squamous cell carcinoma who underwent radical surgery at our hospital between June 2012 and March 2019. The age distribution ranged from 20 to 76 years, with a median age of 52 years. All patients had no positive vaginal stump or parauterine tissue. The first group comprised 322 cases(group1), and postoperative pathological diagnosis revealed that the tumor had infiltrated the entire layer of the cervical wall, with 100% tumor infiltration into the cervical wall, and 89 cases were positive for lymph node involvement. The second group also consisted of 322 patients༈group2༉, and postoperative pathological diagnosis indicated that the cervical wall was not completely infiltrated. The infiltration percentages were as follows: 80% in 1 case, 75% in 9 cases, 66% in 92 cases, 50% in 101 cases, 33% in 92 cases, 30% in 3 cases, 25% in 6 cases, 20% in 13 cases, 10% in 5 cases, and 43 cases had positive lymph nodes. The assessment of the depth of postoperative pathological cancer cell infiltration in all patients was conducted by our pathology department experts, who compared the distance of infiltration under the microscope with the thickness of the cervical wall. For medical records indicating 100% infiltration, it is necessary that the parametrial tissue be negative and the distance between cancer cells and the cervical wall be less than 1-2mm.The measurement of tumor volume is carried out by pathologists in our hospital, who multiply the three-dimensional data of the tumor separately. For example, if the tumor size is 4X3X2 and the unit is centimeters, the volume calculation is 24 cubic centimeters. 1.2 Treatment methods :Upon admission, all patients underwent the necessary examinations and were found to have no contraindications for surgery. A radical uterine and pelvic lymph node dissection was performed, and postoperative radiation therapy was administered based on the Sedlis criteria. In the first group, there were 322 patients, of whom 277 underwent radiation therapy. Out of these, 91 patients received pelvic wide field irradiation post-surgery. Each irradiation session delivered a dose of DT: 2Gy, completed over 20–25 sessions, resulting in a total irradiation dose of 40-50Gy. The irradiation field was bounded superiorly by the fourth to fifth lumbar spine intervertebral spaces, inferiorly by the inferior margin of the obturator foramen, and laterally by 1-1.5cm outside the true pelvis. A fixed source skin distance of 100cm was utilized, with anterior and posterior through irradiation. Additionally, 186 patients received intensity-modulated radiation therapy, targeting the lymphatic drainage area, vaginal stump, and upper vaginal segment. Each session delivered a dose of DT: 2Gy, completed over 20–25 sessions, with a total dose of 40-50Gy. A total of 45 patients did not receive radiation therapy. During radiotherapy, 170 patients were administered platinum-based synchronous systemic chemotherapy. Of these, 65 patients were treated with cisplatin monotherapy once a week, with a cisplatin dosage ranging from 30-40mg/m²; 35 patients received the PF regimen, which included cisplatin 20mg/m² on days 1–5 and fluorouracil 0.5g/m² on days 1–5, or cisplatin 30mg/m² on days 1–3 and fluorouracil 1g/m² on days 1–3; 34 patients underwent TP regimen systemic chemotherapy, with cisplatin 50mg/m² and paclitaxel 135 mg/m²; 28 patients received the TC regimen, involving paclitaxel 135 mg/m²; and 8 patients were treated with other chemotherapy regimens, including Carboplatin AUC = 3–4. In the group2, there were 322 patients. Of these, 209 underwent postoperative radiation therapy, 77 received pelvic field irradiation, and 132 were treated with intensity-modulated radiation therapy (using the specific irradiation method mentioned above). Additionally, 113 did not receive postoperative radiation therapy. During radiotherapy, 103 patients were administered platinum-based synchronous systemic chemotherapy. Among these, 40 patients received weekly cisplatin monotherapy with doses ranging from 30-40mg/m²; 23 cases were treated with the PF regimen, involving cisplatin 20mg/m² on days 1–5 and fluorouracil 0.5g/m² on days 1–5, or cisplatin 30mg/m² on days 1–3 and fluorouracil 1g/m² on days 1–3; 17 cases were given the TP regimen, consisting of cisplatin 50mg/m² and paclitaxel 135 mg/m²; 19 cases underwent total body chemotherapy with the TC regimen, using paclitaxel 135 mg/m²; and carboplatin was administered at an AUC of 3–4 in four cases. Four patients were treated with other chemotherapy regimens. 1.3 Follow up Methods :All patients were followed up for 60 months via telephone, starting from the time of diagnosis and concluding on August 1, 2024. In the first group, 21 patients were lost to follow-up, which accounted for 6.52% of the total. Thirteen patients in the second group were lost to follow-up, resulting in a dropout rate of 4.03%. 1.4 Statistical methods :ROC curves were utilized to analyze tumor volume and 60-month survival outcomes for two groups of patients, and the optimal critical point was selected. Correlation analysis was conducted between the maximum diameter of the tumor (> 4cm, <4cm), infiltration depth (infiltration reached 1/3 of the outer layer in group 2 patients, not considered in group 1 patients), lymph node metastasis (presence or absence), vascular involvement (positive or negative), tumor volume (at the ROC curve boundary point), and the 60-month overall survival rate. The statistical method employed was the Kaplan-Meier method. The Log Rank test was used to compare overall survival rates, with p < 0.05 set as the significance level. A multivariate Cox proportional hazards regression analysis was performed on the critical values of statistical significance from the univariate analysis, also using p < 0.05 as the significance level, to determine the independent factors affecting the prognosis of the two groups of patients. Results Tumor volume and ROC curve analysis of 60-month survival status in two groups of patients: The TV was analyzed using the ROC curve, and the value corresponding to the maximum sensitivity plus specificity minus one was used as the boundary point. This boundary point was used as the basis for the subsequent survival analysis. We found a significant correlation betweenTV and 60 month survival status in Group 1 patients(p0.05).The results are as follows ( Table 1,Table 2and Fingur1 ): 2.2 Single-factor survival analysis results: Utilizing the critical values from Table 1 and Table 2, the two groups were categorized and their survival rates compared using Kaplan-Meier survival analysis and the Log-Rank test. The findings indicated (refer to Table 3,Fingur 2 ) that there was a statistically significant difference in the 60-month survival rate among all groups, based on the critical value of TV, whether the MTD of the tumor exceeded 4cm, presence of VI and occurrence of LNM (p0.05).In Group 2, we observed that TV, MTD,ID and LNM were correlated with the 60-month overall survival rate(p0.05).The results are shown in Table 4 below. 2.3 Results of Multivariate Survival Analysis: Perform a multifactorial Cox proportional hazards regression analysis by grouping under the aforementioned factors. For group1, MTD :HR=0.587, p=0.151,95% CI:0.284-1.215; LNM HR =0.305,p=0.000, 95% CI : 0.175-0.534; VI HR =0.667, p= 0.145, 95% CI=0.387-1.150. TV:HR =0.274, p=0.001, 95% CI =0.132-0.577. With group2, TV :HR =1.588, p=0.418, 95% CI= 0.518-4.872. ID: HR=1.958, p=0.141, 95% CI=0.800-4.796. LNM:HR=2.019, p=0.186, 95% CI=0.712-5.724. IV:HR=1.422, p=0.492, 95% CI=0.521-3.881. MTD:HR=1.642, p=0.415, 95% CI=0.498-5.415. Discussion The Sedlis criteria are used to decide whether adjuvant therapy is necessary for patients with early to mid-stage cervical squamous cell carcinoma; however, there is considerable controversy regarding these criteria. Some scholars argue that adhering to these criteria implies that adjuvant radiotherapy does not affect the prognosis [3] . Upon retrospective analysis, this article has identified that for patients with nearly full-thickness cervical squamous cell carcinoma exhibiting infiltration, lymph node metastasis and tumor volume emerge as independent factors influencing patient prognosis. At this juncture, the maximum diameter of the tumor is less significant in evaluating patient prognosis than tumor volume. Although vascular cancer thrombus notably affects survival rates in univariate analysis, it ceases to be an independent factor in multivariate regression. For cervical squamous cell carcinoma patients with an infiltration depth of less than 100%, we have found that tumor volume, maximum tumor diameter, lymph node metastasis, and infiltration depth were the primary factors affecting patient prognosis in univariate analysis. However, in COX regression, these indicators were not independent factors affecting prognosis. The research concludes that following the onset of cervical cancer, as tumor volume increases and the depth of infiltration deepens, the impact of various risk factors on prognosis evolves. Tumor volume and lymph node metastasis gradually become independent factors affecting patient prognosis. The prognostic evaluation of cervical squamous cell carcinoma patients confirms that the maximum diameter and volume of the tumor are significant factors influencing recurrence. In previous evaluations, the maximum diameter of the tumor was often used as a proxy for assessing tumor volume. However, in patients with an infiltration depth of almost 100%, the tumor volume is more critical than its maximum diameter. The author posits that this is because, in the progression of cervical squamous cell carcinoma, the tumor volume size more accurately reflects the tumor burden. When the tumor infiltrates nearly the entire cervical wall layer, a larger volume of infiltration into the cervical stroma can lead to increased metastasis or a higher likelihood of recurrence, thereby impacting the patient's survival. Other scholars have demonstrated that, prior to radiotherapy for locally advanced cervical cancer, the size of the tumor volume becomes the primary prognostic factor for patients [5] . Previous multivariate survival analyses have identified vascular positivity and lymph node metastasis as independent factors influencing patients' overall survival rates. Vascular positivity notably affects prognosis in patients lacking lymph node metastasis [6-7] . Lymph node metastasis is a significant prognostic factor for patients at various stages of infiltration; however, as infiltration depth increases, its impact on prognosis becomes more pronounced and emerges as an independent factor among multiple variables. In 2018, the FIGO staging of cervical cancer independently categorized lymph node metastasis, facilitating a clearer distinction of patients' survival periods. Findings suggest that deeper vascular infiltration has a more substantial impact on prognosis. The disparities in these outcomes can be attributed to surgical intervention. Following surgical resection of the tumor, the body's tumor burden significantly diminishes, and some patients undergo postoperative adjuvant radiotherapy. Consequently, the local primary tumor ceases to be the primary risk factor. Patients with both positive blood vessels and lymph nodes face a higher risk of lymphatic and blood metastasis. Recurrent multiple lymphatic and systemic metastases in these patients directly impact their overall survival rate. In the nearly 100% infiltration case group, 96 cases were vascular positive and 89 cases were lymph node positive. In the case group with less than 100% infiltration, 61 cases were vascular positive and 43 cases were lymph node positive. As tumor infiltration deepens, the rates of vascular positivity and lymph node metastasis increase, leading to a decline in the 5-year overall survival rate. The impact of intermediate risk factors, identified through pathological examination following cervical cancer surgery, on survival prognosis varies throughout tumor development. As the depth of infiltration increases, the influence of tumor volume, lymph node metastasis, and vascular invasion on prognosis becomes significantly more pronounced. It is essential to reassess various risk factors at different stages of cervical cancer development. Abbreviations tumor volume(TV) vascular invasion(VI) lymph node metastasis(LNM) infiltration depth(ID) maximum tumor diameter(MTD) Declarations Ethics approval This retrospective analysis was reviewed by the Ethics Committee of Shanxi Cancer Hospital in April 2025 and approved for the study, with reference number KY2025037. During the study, the Ethics Committee continued to review all materials and acknowledged that they met ethical requirements.The ethical review criteria for this study are based on the Helsinki Declaration . Exemption from informed consent application This study is a retrospective analysis, and a waiver of informed consent application explanation has been submitted during ethical review. The patients who have undergone treatment in this study were treated according to relevant diagnosis and treatment guidelines, without any new drugs or treatment methods, and no personal information of the patients was displayed in the data in the paper. There was no violation of the patient's privacy rights, and it has been reviewed and approved by our hospital's ethics committee. Consent for publication The articles published in the study do not involve the personal privacy of patients, such as name, ID number, hospitalization number and other information, and each patient agrees to publish other relevant information as a research project when admitted to the hospital. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Funding The article lacks financial support and only collected and analyzed medical records, which were jointly completed by two authors. Authors contribution The first author (Qianni Yang)completed the collection of medical records and data statistics, while the corresponding author(xiaodong Han) completed the overall design of the project. Both authors checked the data in the article and made modifications to it.The two authors have no objection to the contribution and ranking of the article, and this is hereby declared. Competing Interests The two authors declare that this article was completed through the joint efforts of the two authors, and there has been no violation of ethical or academic norms such as theft or falsification. They also guarantee the authenticity and validity of all data, and the two authors have no objection to the author ranking of the article. This is hereby declared. Acknowledgements I would like to express my gratitude to the gynecologists and radiation therapists at the hospital for completing the patient's treatment according to the diagnostic and treatment standards. I would also like to thank the pathologists for carefully observing the postoperative pathological results and providing accurate data in the pathology report. Thank you to the staff in the medical record room for completing the follow-up work of the patients and providing their survival data. Finally, I would like to thank the members of the ethics committee for reviewing the relevant materials of the article. References NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Cervical Cancer Version 1.2023 — April 28, 2023. Kimberly Levinson, Anna L. Beavis, et,cl. Beyond Sedlis-A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An. Jolien Haesen R, Van Salihi T. Gorp,et,cl.Radical hysterectomy without adjuvant radiotherapy in patients with cervix carcinoma FIGO 2009 IB1, with or without positive Sedlis criteria. Gynecol Oncol. 2021;162(3):539–45. Shogo Shigeta M, Shimada K, Tsuji. et,cl. Risk assessment in the patients with uterine cervical cancer harboring intermediate risk factors after radical hysterectomy: a multicenter, retrospective analysis by the Japanese Gynecologic Oncology Group. Int J Clin Oncol. 2022;27(9):1507–1515. Tom RM 1, Perry W, Grigsby. Measurement of tumor volume by PET to evaluate prognosis in patients with advanced cervical cancer treated by radiation therapy.Int J Radiat Oncol Biol Phys. 2002;53(2):353-9. Bogdan Obrzut A, Semczuk. Maciej Naróg, et,cl. Prognostic Parameters for Patients with Cervical Cancer FIGO Stages IA2-IIB: A Long-Term Follow-Up. Oncology. 2017;93(2):106–14. Fraukje JM, Pol, Petra LM, Zusterzeel. Maaike A P C van Ham, et,cl. Satellite lymphovascular space invasion. An independent risk factor in early stage cervical cancer. Gynecol Oncol. 2015;138(3):579–84. Tables Table 1:Tumor volume and ROC curve analysis of 60-month survival status in 1st groups of patients: 95%CI AUC p Boundary Point 0.572-0.728 0.650 0.000 30.81 Table 2: Tumor volume and ROC curve analysis of 60-month survival status in 2nd groups of patients: 95%CI AUC p Boundary Point 0.434-0.696 0.565 0.308 19.50 Table 3: Results of Univariate Survival Analysis Factor n Boundary Point 95%CI OS Chi square p TV 89 ≥30.81 54.012-57.117 66.3% 20.847 0.000 233 <30.81 43.430 -51.076 86.3% LVSI 96 + 46.518-53.072 69.8% 10.759 0.001 226 — 53.085-56.658 85.4% MTD 170 <4 52.402- 56.427 83.5% 2.109 0.146 152 ≥4 49.613-54.583 77.6% LNM 89 yes 42.349 -49.706 59.6% 39.433 0.000 233 no 54.523 -57.610 88.8 % RT 277 yes 51.541-55.008 80.9% 0.052 0.820 45 no 49.872-57.491 80.0% Table 4: Results of Univariate Survival Analysis Factor n Boundary Point 95%CI OS Chi square p TV 65 ≥19.50 51.590-58.274 87.7% 4.350 0.037 257 <19.50 57.551 -59.383 94.5% VI 61 + 53.061-59.409 88.5% 2.748 0.097 261 — 57.090-59.150 94.3% MTD 42 ≥4 49.621- 58.549 85.7% 4.845 0.028 280 <4 57.389-59.237 94.3% LNM 43 yes 49.908 -59.556 86.0% 5.099 0.024 279 no 57.291 -59.155 94.3 % RT 209 yes 56.964-59.920 92.3% 0.664 0.415 113 no 49.872-57.491 94.7% ID 102 ≥66% 53.202-57.993 86.2% 6.051 0.014 220 <66% 57.122 - 59.803 95.5% Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Sep, 2025 Read the published version in BMC Cancer → Version 1 posted Editorial decision: Revision requested 15 May, 2025 Reviews received at journal 13 May, 2025 Reviews received at journal 03 May, 2025 Reviewers agreed at journal 03 May, 2025 Reviewers agreed at journal 29 Apr, 2025 Reviewers invited by journal 29 Apr, 2025 Editor assigned by journal 29 Apr, 2025 Editor invited by journal 11 Apr, 2025 Submission checks completed at journal 10 Apr, 2025 First submitted to journal 10 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6309922","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":451455746,"identity":"576a7a80-3024-4646-ac56-e900a9309675","order_by":0,"name":"Qianni Yang","email":"","orcid":"","institution":"Shanxi Provincial Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qianni","middleName":"","lastName":"Yang","suffix":""},{"id":451455747,"identity":"11384a81-f344-442e-b8e4-82b1f014634c","order_by":1,"name":"Xiaodong Han","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACAxCRwMDA2ADEj/9USMjxk6KF2YDnjIWxZAMxWhggWtgkeNsqEjcQ0mLOfvaYxIMaG9l+6fYLEpLzJBg3MDA/fHQDjxbLnrxkg4RjacYz55wpMDDcJsFszsBmbJyDz2EHcgwfJLAdTtxwIychIXGbBJtlAw+bNF4t598YHEj4B9Fy4OAcCR6DA4S03ADaktgG0pJ+sLGxQUKCCC1vjA0S+4B+mZHDzMxwTMJAspmQX87nmEn++AYMMYn0578Zaurq+9mbHz7GpwUJ8EDjiJk45SDA/oB4taNgFIyCUTCiAADXG1BLvlkULgAAAABJRU5ErkJggg==","orcid":"","institution":"Shanxi Provincial Cancer Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xiaodong","middleName":"","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2025-03-26 07:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6309922/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6309922/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12885-025-14849-8","type":"published","date":"2025-09-02T15:57:44+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82150844,"identity":"1bd91b6e-76a1-4a34-a4dc-8249bd0d0f2b","added_by":"auto","created_at":"2025-05-07 07:18:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55294,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTumor volume and ROC curve analysis of 60-month survival status in 1st groups of patients:\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6309922/v1/b7f4aad450cc43a17a90a33b.png"},{"id":82150843,"identity":"f617a5bb-9d10-48ac-bf34-a779e4d758f9","added_by":"auto","created_at":"2025-05-07 07:18:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":27482,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSurvival curves of different tumor volumes in the first group of patients\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6309922/v1/eb90cd90c1bf66608a229453.png"},{"id":90827963,"identity":"bb1377d4-1e7d-4a38-83c4-e6fdf2e69ce0","added_by":"auto","created_at":"2025-09-08 16:04:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1146664,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6309922/v1/262ee278-b5b7-42c7-816e-8295d8109637.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Risk Factors for Cervical Squamous Cell Carcinoma on Patient Survival Rates at Varying Ratios of Cervical Wall Infiltration Depth ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer is a prevalent form of cancer in developing countries, with surgical treatment and radiation therapy being the primary treatment methods. The intermediate risk factors for postoperative pathology of cervical cancer encompass whether the tumor's maximum diameter exceeds 4cm, the presence of cancer emboli in blood vessels, and whether the depth of invasion reaches one-third of the cervical thickness. High-risk factors include lymph node metastasis, parametrial invasion, and a positive vaginal stump \u003csup\u003e[1]\u003c/sup\u003e. For patients with cervical squamous cell carcinoma, the depth of infiltration is a significant risk factor for tumor recurrence, and this risk escalates with the presence of vascular cancer thrombus\u003csup\u003e\u0026nbsp;[2].\u003c/sup\u003e How do other risk factors influence the prognosis of cervical squamous cell carcinoma at varying depths of infiltration? Currently, there is a lack of research and reporting by scholars in this field. This article retrospectively analyzes patients with cervical squamous cell carcinoma who have undergone surgical treatment at our hospital, examining the impact of other risk factors on patient prognosis at different depths of infiltration.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e1.1Case selection\u003c/strong\u003e:A retrospective analysis was conducted on 644 patients with cervical squamous cell carcinoma who underwent radical surgery at our hospital between June 2012 and March 2019. The age distribution ranged from 20 to 76 years, with a median age of 52 years. All patients had no positive vaginal stump or parauterine tissue. The first group comprised 322 cases(group1), and postoperative pathological diagnosis revealed that the tumor had infiltrated the entire layer of the cervical wall, with 100% tumor infiltration into the cervical wall, and 89 cases were positive for lymph node involvement. The second group also consisted of 322 patients༈group2༉, and postoperative pathological diagnosis indicated that the cervical wall was not completely infiltrated. The infiltration percentages were as follows: 80% in 1 case, 75% in 9 cases, 66% in 92 cases, 50% in 101 cases, 33% in 92 cases, 30% in 3 cases, 25% in 6 cases, 20% in 13 cases, 10% in 5 cases, and 43 cases had positive lymph nodes.\u003c/p\u003e\n\u003cp\u003eThe assessment of the depth of postoperative pathological cancer cell infiltration in all patients was conducted by our pathology department experts, who compared the distance of infiltration under the microscope with the thickness of the cervical wall. For medical records indicating 100% infiltration, it is necessary that the parametrial tissue be negative and the distance between cancer cells and the cervical wall be less than 1-2mm.The measurement of tumor volume is carried out by pathologists in our hospital, who multiply the three-dimensional data of the tumor separately. For example, if the tumor size is 4X3X2 and the unit is centimeters, the volume calculation is 24 cubic centimeters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Treatment methods\u003c/strong\u003e:Upon admission, all patients underwent the necessary examinations and were found to have no contraindications for surgery. A radical uterine and pelvic lymph node dissection was performed, and postoperative radiation therapy was administered based on the Sedlis criteria.\u003c/p\u003e\n\u003cp\u003eIn the first group, there were 322 patients, of whom 277 underwent radiation therapy. Out of these, 91 patients received pelvic wide field irradiation post-surgery. Each irradiation session delivered a dose of DT: 2Gy, completed over 20\u0026ndash;25 sessions, resulting in a total irradiation dose of 40-50Gy. The irradiation field was bounded superiorly by the fourth to fifth lumbar spine intervertebral spaces, inferiorly by the inferior margin of the obturator foramen, and laterally by 1-1.5cm outside the true pelvis. A fixed source skin distance of 100cm was utilized, with anterior and posterior through irradiation. Additionally, 186 patients received intensity-modulated radiation therapy, targeting the lymphatic drainage area, vaginal stump, and upper vaginal segment. Each session delivered a dose of DT: 2Gy, completed over 20\u0026ndash;25 sessions, with a total dose of 40-50Gy. A total of 45 patients did not receive radiation therapy. During radiotherapy, 170 patients were administered platinum-based synchronous systemic chemotherapy. Of these, 65 patients were treated with cisplatin monotherapy once a week, with a cisplatin dosage ranging from 30-40mg/m\u0026sup2;; 35 patients received the PF regimen, which included cisplatin 20mg/m\u0026sup2; on days 1\u0026ndash;5 and fluorouracil 0.5g/m\u0026sup2; on days 1\u0026ndash;5, or cisplatin 30mg/m\u0026sup2; on days 1\u0026ndash;3 and fluorouracil 1g/m\u0026sup2; on days 1\u0026ndash;3; 34 patients underwent TP regimen systemic chemotherapy, with cisplatin 50mg/m\u0026sup2; and paclitaxel 135 mg/m\u0026sup2;; 28 patients received the TC regimen, involving paclitaxel 135 mg/m\u0026sup2;; and 8 patients were treated with other chemotherapy regimens, including Carboplatin AUC\u0026thinsp;=\u0026thinsp;3\u0026ndash;4.\u003c/p\u003e\n\u003cp\u003eIn the group2, there were 322 patients. Of these, 209 underwent postoperative radiation therapy, 77 received pelvic field irradiation, and 132 were treated with intensity-modulated radiation therapy (using the specific irradiation method mentioned above). Additionally, 113 did not receive postoperative radiation therapy. During radiotherapy, 103 patients were administered platinum-based synchronous systemic chemotherapy. Among these, 40 patients received weekly cisplatin monotherapy with doses ranging from 30-40mg/m\u0026sup2;; 23 cases were treated with the PF regimen, involving cisplatin 20mg/m\u0026sup2; on days 1\u0026ndash;5 and fluorouracil 0.5g/m\u0026sup2; on days 1\u0026ndash;5, or cisplatin 30mg/m\u0026sup2; on days 1\u0026ndash;3 and fluorouracil 1g/m\u0026sup2; on days 1\u0026ndash;3; 17 cases were given the TP regimen, consisting of cisplatin 50mg/m\u0026sup2; and paclitaxel 135 mg/m\u0026sup2;; 19 cases underwent total body chemotherapy with the TC regimen, using paclitaxel 135 mg/m\u0026sup2;; and carboplatin was administered at an AUC of 3\u0026ndash;4 in four cases. Four patients were treated with other chemotherapy regimens.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Follow up Methods\u003c/strong\u003e:All patients were followed up for 60 months via telephone, starting from the time of diagnosis and concluding on August 1, 2024. In the first group, 21 patients were lost to follow-up, which accounted for 6.52% of the total. Thirteen patients in the second group were lost to follow-up, resulting in a dropout rate of 4.03%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Statistical methods\u003c/strong\u003e:ROC curves were utilized to analyze tumor volume and 60-month survival outcomes for two groups of patients, and the optimal critical point was selected. Correlation analysis was conducted between the maximum diameter of the tumor (\u0026gt;\u0026thinsp;4cm, \u0026lt;4cm), infiltration depth (infiltration reached 1/3 of the outer layer in group 2 patients, not considered in group 1 patients), lymph node metastasis (presence or absence), vascular involvement (positive or negative), tumor volume (at the ROC curve boundary point), and the 60-month overall survival rate. The statistical method employed was the Kaplan-Meier method. The Log Rank test was used to compare overall survival rates, with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 set as the significance level. A multivariate Cox proportional hazards regression analysis was performed on the critical values of statistical significance from the univariate analysis, also using p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 as the significance level, to determine the independent factors affecting the prognosis of the two groups of patients.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTumor volume and ROC curve analysis of 60-month survival status in two groups of patients: The TV was analyzed using the ROC curve, and the value corresponding to the maximum sensitivity plus specificity minus one was used as the boundary point. This boundary point was used as the basis for the subsequent survival analysis. We found a significant correlation betweenTV and 60 month survival status in Group 1 patients(p\u0026lt;0.001), but the correlation was poor in Group 2 patients(p\u0026gt;0.05).The results are as follows (\u003cstrong\u003eTable 1,Table 2and Fingur1\u003c/strong\u003e):\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSingle-factor survival analysis results:\u0026nbsp;\u003c/strong\u003eUtilizing the critical values from Table 1 and Table 2, the two groups were categorized and their survival rates compared using Kaplan-Meier survival analysis and the Log-Rank test. The findings indicated (refer to\u003cstrong\u003e\u0026nbsp;Table 3,Fingur 2\u003c/strong\u003e) that there was a statistically significant difference in the 60-month survival rate among all groups, based on the critical value of TV, whether the MTD of the tumor exceeded 4cm, presence of VI and occurrence of LNM (p\u0026lt;0.05). However, there was no statistically significant difference in the survival rate for postoperative radiotherapy (p\u0026gt;0.05).In Group 2, we observed that TV, MTD,ID and LNM were correlated with the 60-month overall survival rate(p\u0026lt;0.05), whereas the vascular univariate survival analysis was not significant (p\u0026gt;0.05).The results are shown in \u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003ebelow.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eResults of Multivariate Survival Analysis:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePerform a multifactorial Cox proportional hazards regression analysis by grouping under the aforementioned factors. For group1, MTD :HR=0.587, p=0.151,95% CI:0.284-1.215; LNM \u0026nbsp;HR =0.305,p=0.000, 95% CI : 0.175-0.534; VI \u0026nbsp;HR =0.667, p= 0.145, 95% CI=0.387-1.150. TV:HR =0.274, p=0.001, 95% CI =0.132-0.577.\u003c/p\u003e\n\u003cp\u003eWith group2, TV :HR =1.588, p=0.418, \u0026nbsp; 95% CI= 0.518-4.872. ID: HR=1.958, p=0.141, 95% CI=0.800-4.796. LNM:HR=2.019, p=0.186, 95% CI=0.712-5.724. IV:HR=1.422, p=0.492, 95% CI=0.521-3.881. MTD:HR=1.642, p=0.415, 95% CI=0.498-5.415.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe Sedlis criteria are used to decide whether adjuvant therapy is necessary for patients with early to mid-stage cervical squamous cell carcinoma; however, there is considerable controversy regarding these criteria. Some scholars argue that adhering to these criteria implies that adjuvant radiotherapy does not affect the prognosis\u003csup\u003e[3]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Upon retrospective analysis, this article has identified that for patients with nearly full-thickness cervical squamous cell carcinoma exhibiting infiltration, lymph node metastasis and tumor volume emerge as independent factors influencing patient prognosis. At this juncture, the maximum diameter of the tumor is less significant in evaluating patient prognosis than tumor volume. Although vascular cancer thrombus notably affects survival rates in univariate analysis, it ceases to be an independent factor in multivariate regression. For cervical squamous cell carcinoma patients with an infiltration depth of less than 100%, we have found that tumor volume, maximum tumor diameter, lymph node metastasis, and infiltration depth were the primary factors affecting patient prognosis in univariate analysis. However, in COX regression, these indicators were not independent factors affecting prognosis. The research concludes that following the onset of cervical cancer, as tumor volume increases and the depth of infiltration deepens, the impact of various risk factors on prognosis evolves. Tumor volume and lymph node metastasis gradually become independent factors affecting patient prognosis.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; The prognostic evaluation of cervical squamous cell carcinoma patients confirms that the maximum diameter and volume of the tumor are significant factors influencing recurrence. In previous evaluations, the maximum diameter of the tumor was often used as a proxy for assessing tumor volume. However, in patients with an infiltration depth of almost 100%, the tumor volume is more critical than its maximum diameter. The author posits that this is because, in the progression of cervical squamous cell carcinoma, the tumor volume size more accurately reflects the tumor burden. When the tumor infiltrates nearly the entire cervical wall layer, a larger volume of infiltration into the cervical stroma can lead to increased metastasis or a higher likelihood of recurrence, thereby impacting the patient's survival. Other scholars have demonstrated that, prior to radiotherapy for locally advanced cervical cancer, the size of the tumor volume becomes the primary prognostic factor for patients \u003csup\u003e[5]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Previous multivariate survival analyses have identified vascular positivity and lymph node metastasis as independent factors influencing patients' overall survival rates. Vascular positivity notably affects prognosis in patients lacking lymph node metastasis\u003csup\u003e\u0026nbsp;[6-7]\u003c/sup\u003e. Lymph node metastasis is a significant prognostic factor for patients at various stages of infiltration; however, as infiltration depth increases, its impact on prognosis becomes more pronounced and emerges as an independent factor among multiple variables. In 2018, the FIGO staging of cervical cancer independently categorized lymph node metastasis, facilitating a clearer distinction of patients' survival periods. Findings suggest that deeper vascular infiltration has a more substantial impact on prognosis. The disparities in these outcomes can be attributed to surgical intervention. Following surgical resection of the tumor, the body's tumor burden significantly diminishes, and some patients undergo postoperative adjuvant radiotherapy. Consequently, the local primary tumor ceases to be the primary risk factor. Patients with both positive blood vessels and lymph nodes face a higher risk of lymphatic and blood metastasis. Recurrent multiple lymphatic and systemic metastases in these patients directly impact their overall survival rate. In the nearly 100% infiltration case group, 96 cases were vascular positive and 89 cases were lymph node positive. In the case group with less than 100% infiltration, 61 cases were vascular positive and 43 cases were lymph node positive. As tumor infiltration deepens, the rates of vascular positivity and lymph node metastasis increase, leading to a decline in the 5-year overall survival rate.\u003c/p\u003e\n\u003cp\u003eThe impact of intermediate risk factors, identified through pathological examination following cervical cancer surgery, on survival prognosis varies throughout tumor development. As the depth of infiltration increases, the influence of tumor volume, lymph node metastasis, and vascular invasion on prognosis becomes significantly more pronounced. It is essential to reassess various risk factors at different stages of cervical cancer development.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003etumor volume(TV)\u003c/p\u003e \u003cp\u003evascular invasion(VI)\u003c/p\u003e \u003cp\u003elymph node metastasis(LNM)\u003c/p\u003e \u003cp\u003einfiltration depth(ID)\u003c/p\u003e \u003cp\u003emaximum tumor diameter(MTD)\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch4\u003eEthics approval\u0026nbsp;\u003c/h4\u003e\n\u003cp\u003eThis retrospective analysis was reviewed by the Ethics Committee of Shanxi Cancer Hospital in April 2025 and approved for the study, with reference number KY2025037. During the study, the Ethics Committee continued to review all materials and acknowledged that they met ethical requirements.The ethical review criteria for this study are based on the \u003cstrong\u003eHelsinki Declaration\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExemption from informed consent application\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a retrospective analysis, and a waiver of informed consent application explanation has been submitted during ethical review. The patients who have undergone treatment in this study were treated according to relevant diagnosis and treatment guidelines, without any new drugs or treatment methods, and no personal information of the patients was displayed in the data in the paper. There was no violation of the patient\u0026apos;s privacy rights, and it has been reviewed and approved by our hospital\u0026apos;s ethics committee.\u003c/p\u003e\n\u003ch4\u003eConsent for publication\u003c/h4\u003e\n\u003cp\u003eThe articles published in the study do not involve the personal privacy of patients, such as name, ID number, hospitalization number and other information, and each patient agrees to publish other relevant information as a research project when admitted to the hospital.\u003c/p\u003e\n\u003ch4\u003eAvailability of data and materials\u003c/h4\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe article lacks financial support and only collected and analyzed medical records, which were jointly completed by two authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first author (Qianni Yang)completed the collection of medical records and data statistics, while the corresponding author(xiaodong Han) completed the overall design of the project. Both authors checked the data in the article and made modifications to it.The two authors have no objection to the contribution and ranking of the article, and this is hereby declared.\u003c/p\u003e\n\u003cp skip=\"true\"\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe two authors declare that this article was completed through the joint efforts of the two authors, and there has been no violation of ethical or academic norms such as theft or falsification. They also guarantee the authenticity and validity of all data, and the two authors have no objection to the author ranking of the article. This is hereby declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp skip=\"true\"\u003eI would like to express my gratitude to the gynecologists and radiation therapists at the hospital for completing the patient\u0026apos;s treatment according to the diagnostic and treatment standards. I would also like to thank the pathologists for carefully observing the postoperative pathological results and providing accurate data in the pathology report. Thank you to the staff in the medical record room for completing the follow-up work of the patients and providing their survival data. Finally, I would like to thank the members of the ethics committee for reviewing the relevant materials of the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u0026reg;). Cervical Cancer Version 1.2023 \u0026mdash; April 28, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKimberly Levinson, Anna L. Beavis, et,cl. Beyond Sedlis-A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJolien Haesen R, Van Salihi T. Gorp,et,cl.Radical hysterectomy without adjuvant radiotherapy in patients with cervix carcinoma FIGO 2009 IB1, with or without positive Sedlis criteria. Gynecol Oncol. 2021;162(3):539\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShogo Shigeta M, Shimada K, Tsuji. et,cl. Risk assessment in the patients with uterine cervical cancer harboring intermediate risk factors after radical hysterectomy: a multicenter, retrospective analysis by the Japanese Gynecologic Oncology Group. Int J Clin Oncol. 2022;27(9):1507\u0026ndash;1515.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTom RM 1, Perry W, Grigsby. Measurement of tumor volume by PET to evaluate prognosis in patients with advanced cervical cancer treated by radiation therapy.Int J Radiat Oncol Biol Phys. 2002;53(2):353-9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBogdan Obrzut A, Semczuk. Maciej Nar\u0026oacute;g, et,cl. Prognostic Parameters for Patients with Cervical Cancer FIGO Stages IA2-IIB: A Long-Term Follow-Up. Oncology. 2017;93(2):106\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFraukje JM, Pol, Petra LM, Zusterzeel. Maaike A P C van Ham, et,cl.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSatellite lymphovascular space invasion. An independent risk factor in early stage cervical cancer. Gynecol Oncol. 2015;138(3):579\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:Tumor volume and ROC curve analysis of 60-month survival status in 1st groups of patients:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.4257%;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.604%;\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.4851%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4851%;\"\u003e\n \u003cp\u003eBoundary Point\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.4257%;\"\u003e\n \u003cp\u003e0.572-0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.604%;\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.4851%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.4851%;\"\u003e\n \u003cp\u003e30.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Tumor volume and ROC curve analysis of 60-month survival status in 2nd \u0026nbsp;groups of patients:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eBoundary Point\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e0.434-0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e19.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Results of Univariate Survival Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eBoundary Point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi square\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e89\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026ge;30.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e54.012-57.117\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e66.3%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20.847\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e233\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;30.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;43.430\u003c/strong\u003e\u003cstrong\u003e-51.076\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e86.3%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLVSI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e96\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46.518-53.072\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e69.8%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.759\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 226\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e53.085-56.658\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e85.4%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMTD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e170\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e52.402-\u003c/strong\u003e\u003cstrong\u003e56.427\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e83.5%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.109\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.146\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 152\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026ge;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e49.613-54.583\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e77.6%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLNM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e89\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e42.349\u003c/strong\u003e\u003cstrong\u003e-49.706\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e59.6%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e39.433\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e233\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e54.523\u003c/strong\u003e\u003cstrong\u003e-57.610\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e88.8\u003c/strong\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e277\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e51.541-55.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e80.9%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.052\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.820\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e45\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e49.872-57.491\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e80.0%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Results of Univariate Survival Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eBoundary Point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi square\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e65\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026ge;19.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e51.590-58.274\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e87.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.350\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e257\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;19.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;57.551\u003c/strong\u003e\u003cstrong\u003e-59.383\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e94.5%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e61\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e53.061-59.409\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e88.5%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.748\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.097\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;261\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e57.090-59.150\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e94.3%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMTD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e42\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026ge;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e49.621-\u003c/strong\u003e\u003cstrong\u003e58.549\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e85.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.845\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e280\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n 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\u003c/tbody\u003e\n\u003c/table\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cervical carcinoma, prognostic factor, vascular invasion, lymph node metastasis, radiotherapy","lastPublishedDoi":"10.21203/rs.3.rs-6309922/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6309922/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To investigate whether there are alterations in the influence of various risk factors on the prognosis of patients with cervical squamous cell carcinoma at different infiltration depths.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective analysis was performed on 644 patients admitted to our hospital between July 2012 and March 2019. Based on postoperative pathological results, the first group (n=322) had cervical wall infiltration approaching nearly 100%, while the second group (n=322) had infiltration below 80%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Univariate analysis revealed that the primary factors affecting patient prognosis in Group 1 were tumor volume(TV), vascular invasion(VI), and lymph node metastasis(LNM) (p\u0026lt;0.01), and maximum tumor diameter(MTD) (p=0.146); Group 2: TV, infiltration depth(ID), and LNM(p\u0026lt;0.05), VI (p=0.097). Multivariate analysis: In Group 1, TV and LNM were independent prognostic factors (p\u0026lt;0.05), whereas Group 2 had no independent prognostic factors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eAs infiltration depth increases, the impact of TV, LNM, and VI factors on the prognosis of patients with cervical squamous cell carcinoma significantly rises, with TV having a more pronounced effect on prognosis than tumor maximum diameter.\u003c/p\u003e","manuscriptTitle":"The Impact of Risk Factors for Cervical Squamous Cell Carcinoma on Patient Survival Rates at Varying Ratios of Cervical Wall Infiltration Depth ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 07:18:17","doi":"10.21203/rs.3.rs-6309922/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-15T21:04:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-14T02:27:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-03T13:18:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325195742823078219440161602261309469977","date":"2025-05-03T13:02:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43472950653891445752058510233303341364","date":"2025-04-29T18:11:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-29T17:58:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T11:04:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-11T09:24:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-10T09:15:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2025-04-10T09:13:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8ba73ffd-6dca-4635-b006-f64e76828375","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-08T16:00:40+00:00","versionOfRecord":{"articleIdentity":"rs-6309922","link":"https://doi.org/10.1186/s12885-025-14849-8","journal":{"identity":"bmc-cancer","isVorOnly":false,"title":"BMC Cancer"},"publishedOn":"2025-09-02 15:57:44","publishedOnDateReadable":"September 2nd, 2025"},"versionCreatedAt":"2025-05-07 07:18:17","video":"","vorDoi":"10.1186/s12885-025-14849-8","vorDoiUrl":"https://doi.org/10.1186/s12885-025-14849-8","workflowStages":[]},"version":"v1","identity":"rs-6309922","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6309922","identity":"rs-6309922","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}