Abstract
Background: The present study was aimed at developing nomograms estimating the overall survival (OS) and cancer-specific survival (CSS) of endometrial cancer (EC)-affected patients.Patients and Methods: We retrospectively collected 145,445 EC patients between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Independent prognostic factors were identified via univariate and multivariate Cox analyses. These risk factors were used to establish nomograms to predict 3- and 5-year OS and CSS rates. Internal and external data were used for validation. The predictive accuracy and discriminative ability were measured by using concordance index (C-index) and risk group stratification.Results: A total of 63,510 patients were collected and randomly assigned into the training cohort (n = 42,340) and the validation cohort (n = 21,170). Age at diagnosis, marital status, tumor size, histologic type, lymph node metastasis, tumor grade, and clinical stage were identified as independent prognostic factors for OS and CSS (p < 0.05 according to multivariate Cox analysis) and were further used to construct the nomograms. The area under the receiver operating characteristics (ROC) curve was greater than that of International Federation of Gynecology and Obstetrics (FIGO) staging system for predicting OS (0.83 vs. 0.73, p < 0.01) and CSS (0.87 vs. 0.79, p < 0.01) in the training cohort. The stratification into different risk groups ensured a significant distinction between survival curves within different FIGO staging categories.Conclusion: We constructed and validated nomograms that accurately predicting OS and CSS in EC patients. The nomograms can be used for estimating OS and CSS of individual patients and establishing their risk stratification.
Highlights
Endometrial cancer (EC) is the most common gynecologic malignancy in the United States [1], with an increased number of cases in China, especially in young women [2]
During the 2004–2015 time period, a total of 145,445 patients with endometrial cancer were identified from the SEER database
37,041 (87.48%) patients were diagnosed with endometrial endometrioid adenocarcinoma (EEA), 3,185 (7.52%) patients with SEA, and 2,114 (4.99%) patients were diagnosed with other cancer types
Summary
Endometrial cancer (EC) is the most common gynecologic malignancy in the United States [1], with an increased number of cases in China, especially in young women [2]. Several prognostic risk factors have been associated with the overall survival. Nomogram is a statistical prediction tool that incorporates all prognostic factors to calculate the risk score of each patient and estimate the survival outcome for the individual, as has been widely demonstrated in other cancers such as breast cancer, gastric cancer, and ovarian cancer [6,7,8]. A nomogram which includes available prognostic factors and that is based on a large cohort to predict the overall survival (OS) and cancer-specific survival (CSS) of EC patients has not recently been reported yet. The present study was aimed at developing nomograms estimating the overall survival (OS) and cancer-specific survival (CSS) of endometrial cancer (EC)-affected patients
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