Abstract
ObjectiveStage I‐II uterine papillary serous carcinoma (UPSC) has aggressive biological behavior and leads to poor prognosis. However, clinicopathologic risk factors to predict cancer‐specific survival of patients with stage I‐II UPSC were still unclear. This study was undertaken to develop a prediction model of survival in patients with early‐stage UPSC.MethodsUsing Surveillance, Epidemiology, and End Results (SEER) database, 964 patients were identified with International Federation of Gynecology and Obstetrics (FIGO) stage I‐II UPSC who underwent at least hysterectomy between 2004 and 2015. By considering competing risk events for survival outcomes, we used proportional subdistribution hazards regression to compare cancer‐specific death (CSD) for all patients. Based on the results of univariate and multivariate analysis, the variables were selected to construct a predictive model; and the prediction results of the model were visualized using a nomogram to predict the cancer‐specific survival and the response to adjuvant chemotherapy and radiotherapy of stage I‐II UPSC patients.ResultsThe median age of the cohort was 67 years. One hundred and sixty five patients (17.1%) died of UPSC (CSD), while 8.6% of the patients died from other causes (non‐CSD). On multivariate analysis, age ≥ 67 (HR = 1.45, P = .021), tumor size ≥ 2 cm (HR = 1.81, P = .014) and >10 regional nodes removed (HR = 0.52, P = .002) were significantly associated with cumulative incidence of CSD. In the age ≥67 cohort, FIGO stage IB‐II was a risk factor for CSD (HR = 1.83, P = .036), and >10 lymph nodes removed was a protective factor (HR = 0.50, P = .01). Both adjuvant chemotherapy combined with radiotherapy and adjuvant chemotherapy alone decreased CSD of patients with stage I‐II UPSC older than 67 years (HR = 0.47, P = .022; HR = 0.52, P = .024, respectively). The prediction model had great risk stratification ability as the high‐risk group had higher cumulative incidence of CSD than the low‐risk group (P < .001). In the high‐risk group, patients with post‐operative adjuvant chemoradiotherapy had improved CSD compared with patients who did not receive radiotherapy nor chemotherapy (P = .037). However, there was no such benefit in the low‐risk group.ConclusionOur prediction model of CSD based on proportional subdistribution hazards regression showed a good performance in predicting the cancer‐specific survival of early‐stage UPSC patients and contributed to guide clinical treatment decision, helping oncologists and patients with early‐stage UPSC to decide whether to choose adjuvant therapy or not.
Highlights
Endometrial cancer is the most common gynecological malignant tumor and the fourth common cause of cancer death with an increasing incidence rate among women in America.[1,2] Uterine papillary serous carcinoma (UPSC) belongs to type II endometrial carcinoma
Our prediction model of cancer‐specific death (CSD) based on proportional subdistribution hazards regression showed a good performance in predicting the cancer‐specific survival of early‐stage uterine papillary serous carcinoma (UPSC) patients and contributed to guide clinical treatment decision, helping oncologists and patients with early‐stage UPSC to decide whether to choose adjuvant therapy or not
The analysis suggested that age ≥ 67 years and tumor size ≥ 2 cm were associated with increased CSD of early‐ stage UPSC patients, while >10 lymph nodes removed was correlated with improved CSD
Summary
Endometrial cancer is the most common gynecological malignant tumor and the fourth common cause of cancer death with an increasing incidence rate among women in America.[1,2] Uterine papillary serous carcinoma (UPSC) belongs to type II endometrial carcinoma. Unlike type I endometrial cancer, UPSC is a non‐hormone dependent tumor. UPSC is a rare histologic subtype of endometrial carcinoma that is highly invasive and extremely liable to occur extrauterine spreading and lymph node metastasis. As a biologically aggressive subtype of Type II endometrial cancer, whether the clinicopathological risk factors like age, grade, disease stage and lymph vascular space invasion (LVSI) in Type I carcinomas suit for UPSC is undefined.[7]. Some small‐cohort studies have explored the prognostic factors for clinical outcomes in UPSC,[8,9] and a straightforward prediction model based on large‐scale population for UPSC is still unknown. Our study aimed to develop an explicit prognostic model based on proportional subdistribution hazards regression which predicts the cancer‐specific death for UPSC patients by analyzing the Surveillance, Epidemiology, and End Results (SEER) database
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