A Novel Tool to Predict Early Death in Uterine Sarcoma Patients: A Surveillance, Epidemiology, and End Results-Based Study.

Zixuan Song,Dandan Zhang,Yangzi Zhou,Yizi Wang

doi:10.3389/fonc.2020.608548

Abstract

BackgroundUterine sarcoma is a rare gynecologic tumor with a high degree of malignancy. There is a lack of effective prognostic tools to predict early death of uterine sarcoma.MethodsData on patients with uterine sarcoma registered between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) data. Important independent prognostic factors were identified by univariate and multivariate logistic regression analyses to construct a nomogram for total early deaths and cancer-specific early deaths.ResultsA total of 5,274 patients with uterine sarcoma were included in this study. Of which, 397 patients experienced early death (≤3 months), and 356 of whom died from cancer-specific causes. A nomogram for total early deaths and cancer-specific early deaths was created using data on age, race, tumor size, the International Federation of Gynecology and Obstetrics (FIGO) staging, histological classification, histological staging, treatment (surgery, radiotherapy, chemotherapy), and brain metastases. On comparing the C-index, area under the curve, and decision curve analysis, the created nomogram showed better predictive power and clinical practicality than one made exclusively with FIGO staging. Calibration of the nomogram by internal validation showed good consistency between the predicted and actual early death.ConclusionsNomograms that include clinical characteristics can provide a better prediction of the risk of early death for uterine sarcoma patients than nomograms only comprising the FIGO stage system. In doing so, this tool can help in identifying patients at high risk for early death because of uterine sarcoma.

Highlights

Uterine sarcoma is a rare gynecologic malignancy with poor prognosis and comprises approximately 1% of female genital malignancies and 3%–7% of uterine tumors [1, 2]
Nomograms were constructed to predict early death in patients with uterine sarcoma based on associated risk factors
The clinical effects of the nomogram were evaluated by a decision curve analysis (DCA) [13] that calculated the net gain at each risk threshold probability

Summary

Introduction

Uterine sarcoma is a rare gynecologic malignancy with poor prognosis and comprises approximately 1% of female genital malignancies and 3%–7% of uterine tumors [1, 2]. It is mainly divided into two categories: a) mesenchymal tumors and b) mixed epithelial and mesenchymal tumors. In a study of advanced soft tissue sarcomas, the authors performed a retrospective analysis and established a prognostic model of early death within 3 months [7]. No study thoroughly investigates the 3month mortality rate of uterine sarcoma patients, warranting the need for a predictive model for the early death in these patients. There is a lack of effective prognostic tools to predict early death of uterine sarcoma

Methods

Results

Conclusion