The validity of the MSKCC nomogram in predicting overall survival of black patients with uterine cancer.

Abstract

e15570 Background: To test the validity of a MSKCC nomogram for predicting overall survival in black women with uterine cancer. Methods: Retrospective review of a uterine cancer database at two major teaching institutions identified 636 eligible black patients with uterine cancer who underwent surgery between 1984 and 2009. We compared actual survival at the time of analysis to that predicted by the MSKCC nomogram based on age at diagnosis, grade, stage, histologic subtype, and number of negative lymph nodes. Subjects were divided into quartiles based on their model-based survival probability; Kaplan-Meier (KM) analysis was then applied to generate an independent estimate of survival probability for each quartile, along with a 95% confidence interval (CI). Results: The median age was 64 years (range; 28-100). Final grade included: G1 (n=253), G2 (n=187), G3 (n=391) and missing (4). Stage included: IA (n=149), IB (n=244), IC (n=76), IIA (n=28), IIB (n=62), IIIA (n=32), IIIB (16), IIIC (n=97), IVA (n=16), and IVB (n=115). Histology included: adenocarcinoma (561), carcinosarcoma (158), serous (93) and clear cell carcinoma (23). Median follow-up for survivors was 54 months (range; 1–274 months). For women in the upper two quartiles, the model-based probability of survival at 3 years was 0.976 and 0.924, and the KM for our patient population was 0.983 (95% CI 0.024) and 0.857 (95% CI 0.061), respectively. For women in the lower two quartiles the model-based probability of survival at 3 years was 0.761 and 0.331, and the KM estimate for our patient population was 0.700 (95% CI 0.080) and 0.174 (95% CI 0.063), respectively. Results regarding five-year survival for the upper two quartiles was 0.958 and 0.879, the KM estimate for our patients was 0.938 (95% CI 0.023) and 0.786 (95% CI 0.037) respectively. For patients in the lower two quartiles, the model-based probability was 0.645 and 0.183, and the KM estimates were 0.498 (95% CI 0.044) and 0.183 (95% CI 0.028) respectively. Conclusions: The nomogram is a good predictor of survival in black patients who are young and with early stages of disease. In contrast, the nomogram performed poorly in predicting survival in black patients who were elderly or had advanced stage disease.