A federated approach to identify women with early-stage cervical cancer at low risk of lymph node metastases

Hans H.B. Wenzel*, Anna N. Hardie, Arturo Moncada-Torres, Claus K. Høgdall, Ruud L.M. Bekkers, Henrik Falconer, Pernille T. Jensen, Hans W. Nijman, Maaike A. van der Aa, Frank Martin, Anna J. van Gestel, Valery E.P.P. Lemmens, Pernilla Dahm-Kähler, Emilia Alfonzo, Jan Persson, Linnea Ekdahl, Sahar Salehi, Ligita P. Frøding, Algirdas Markauskas, Katrine FuglsangTine H. Schnack

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Objective: Lymph node metastases (pN+) in presumed early-stage cervical cancer negatively impact prognosis. Using federated learning, we aimed to develop a tool to identify a group of women at low risk of pN+, to guide the shared decision-making process concerning the extent of lymph node dissection. Methods: Women with cervical cancer between 2005 and 2020 were identified retrospectively from population-based registries: the Danish Gynaecological Cancer Database, Swedish Quality Registry for Gynaecologic Cancer and Netherlands Cancer Registry. Inclusion criteria were: squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma; The International Federation of Gynecology and Obstetrics 2009 IA2, IB1 and IIA1; treatment with radical hysterectomy and pelvic lymph node assessment. We applied privacy-preserving federated logistic regression to identify risk factors of pN+. Significant factors were used to stratify the risk of pN+. Results: We included 3606 women (pN+ 11%). The most important risk factors of pN+ were lymphovascular space invasion (LVSI) (odds ratio [OR] 5.16, 95% confidence interval [CI], 4.59–5.79), tumour size 21–40 mm (OR 2.14, 95% CI, 1.89–2.43) and depth of invasion>10 mm (OR 1.81, 95% CI, 1.59–2.08). A group of 1469 women (41%)—with tumours without LVSI, tumour size ≤20 mm, and depth of invasion ≤10 mm—had a very low risk of pN+ (2.4%, 95% CI, 1.7–3.3%). Conclusion: Early-stage cervical cancer without LVSI, a tumour size ≤20 mm and depth of invasion ≤10 mm, confers a low risk of pN+. Based on an international privacy-preserving analysis, we developed a useful tool to guide the shared decision-making process regarding lymph node dissection.

Original languageEnglish
JournalEuropean Journal of Cancer
Volume185
Pages (from-to)61-68
ISSN0959-8049
DOIs
Publication statusPublished - May 2023

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Ltd

Keywords

  • Cervical cancer
  • Federated learning
  • Lymph node metastases
  • Risk factors

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