Abstract
This study aimed at developing an available recurrence-free survival (RFS) model of endometrial cancer (EC) for accurate and individualized prognosis assessment. A training cohort of 520 women with EC who underwent initial surgical treatment and an external validation cohort of 445 eligible EC patients from 2006 to 2016 were analyzed retrospectively. Multivariable Cox proportional hazards regression models were used to develop nomograms for predicting recurrence. The concordance index (C-index) and the area under the receiver operating characteristic curve (AUC) were calculated to determine the discrimination of RFS prognostic scoring systems. Calibration plots were generated to examine the performance characteristics of the predictive nomograms. Regression analysis revealed that an advanced International Federation of Gynecology and Obstetrics (FIGO) stage, histological grade 3, primary tumor diameter ≥2 cm, and positive peritoneal cytology were independent prognostic factors for RFS in EC in the training set. The nomograms estimated RFS according to these four variables, with a C-index of 0.860, which was superior to that of FIGO stage (2009 criteria), at 0.809 (P=0.034), in the training cohort. Encouragingly, consistent results were observed in the validation set, with a C-index of 0.875 for the nomogram and a C-index of 0.833 for the FIGO staging (P=0.0137). Furthermore, the calibrations of the nomograms predicting 3- and 5-year RFS strongly corresponded to the actual survival outcome. In conclusion, this study developed an available nomogram with effective external validation and relatively appreciable discrimination and conformity for the accurate assessment of 3- and 5-year RFS in Chinese women with EC.
Highlights
Endometrial cancer (EC) is the most common gynecological malignancy, ranking as the fourth among female tumors in developed countries [1]
Predictive nomograms for the assessment of EC prognosis and recurrence have preliminarily been well developed in Europe and the United States [10, 15]
We developed a nomogram to predict recurrence in women with EC in China, which was well validated in an independent cohort from Fudan University Shanghai Cancer Center
Summary
Endometrial cancer (EC) is the most common gynecological malignancy, ranking as the fourth among female tumors in developed countries [1]. Nonendometrioid endometrial cancer which includes uterine serous carcinoma, clear cell cancer, and carcinosarcoma was identified as type II and accounts for about 35%. E 5-year overall survival of type I and type II was about 85% and 55%, respectively [4]. EC is detected early in most cases and patients begin receiving appropriate treatment with a good prognosis, the 5-year overall survival of patients with stage I–III EC ranges from 57% to 91% and with stage IV is 20–26% [5,6,7]. E prognosis of endometrial cancer is affected by many other factors such as age, tumor grade, and positive peritoneal cytology.
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