一种新型的子宫内膜样腺癌淋巴扩散多变量预测模型：淋巴结转移风险指数。

A novel multivariable prediction model for lymphatic dissemination in endometrioid endometrial cancer: The lymph node Metastasis Risk Index.

机构信息

Zekai Tahir Burak Women's Health Hospital, Talatpasa Blv, Ankara, Turkey.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:310-315. doi: 10.1016/j.ejogrb.2019.07.015. Epub 2019 Jul 25.

DOI:10.1016/j.ejogrb.2019.07.015

PMID:31377459

Abstract

OBJECTIVE

The purpose of this study was to develop a risk assessment index that could determine which endometrioid endometrial cancer (EC) patients would benefit from a lymphadenectomy.

METHODS

The final pathology reports of 353 women who underwent complete surgical staging, including pelvic and para-aortic lymphadenectomy, for endometrioid EC between January 2008 and June 2018 were retrospectively reviewed. A logistic regression was used to investigate the clinicopathological factors associated with a positive nodal status. The independent risk factors for lymphatic dissemination were used to build a risk model and a "Lymph Node (LN) Metastasis Risk Index" was defined as follows: (tumor grade) × (primary tumor diameter) × (percentage of myometrial invasion) × (preoperative serum CA 125 level). The scores used in the LN Metastasis Risk Index were weighted according to the odds ratios assigned for each variable. The diagnostic performance of the model was expressed as the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio.

RESULTS

The LN Metastasis Risk Index correctly identified 35 of 40 LN-positive women at a cutoff point of 981.0 (sensitivity: 87.5%, specificity: 86.3%, negative predictive value: 98.2%, positive predictive value: 44.9%, positive likelihood ratio: 6.37, and negative likelihood ratio: 0.14). The area under the receiver operating characteristic curve was 0.90 (95% confidence interval = 0.858-0.947) at this cutoff. The clinical accuracy of the model was 86.4%. When a cutoff point of <981.0 was selected in order to define those women at low-risk for lymphatic dissemination, our prediction model classified 275 women (77.9%) as being at low-risk for nodal involvement. Among these 275 women, 5 actually had positive LNs, which indicated a 1.8% false-negative rate.

CONCLUSION

After external validation, the LN Metastasis Risk Index may be a valuable tool for the surgical management of endometrioid EC.

摘要

目的

本研究旨在开发一种风险评估指数，以确定哪些子宫内膜样型子宫内膜癌（EC）患者将从淋巴结切除术获益。

方法

回顾性分析了 2008 年 1 月至 2018 年 6 月期间 353 例接受完整手术分期（包括盆腔和腹主动脉旁淋巴结切除术）的子宫内膜样型 EC 患者的最终病理报告。采用 logistic 回归分析与淋巴结阳性状态相关的临床病理因素。将淋巴扩散的独立危险因素用于构建风险模型，并定义“淋巴结（LN）转移风险指数”如下：（肿瘤分级）×（原发肿瘤直径）×（肌层浸润百分比）×（术前血清 CA125 水平）。LN 转移风险指数中的评分根据为每个变量分配的比值比进行加权。模型的诊断性能用灵敏度、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比表示。

结果

LN 转移风险指数在截止值为 981.0 时正确识别了 40 例 LN 阳性女性中的 35 例（灵敏度：87.5%，特异性：86.3%，阴性预测值：98.2%，阳性预测值：44.9%，阳性似然比：6.37，阴性似然比：0.14）。该截止值下，受试者工作特征曲线下面积为 0.90（95%置信区间=0.858-0.947）。该模型的临床准确性为 86.4%。当选择<981.0 的截止值以定义那些淋巴扩散低风险的女性时，我们的预测模型将 275 名（77.9%）女性归类为淋巴结受累的低风险。在这 275 名女性中，实际上有 5 名存在阳性 LN，假阴性率为 1.8%。