Department of Obstetrics and Gynecology, Maternal and Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Cancer Med. 2021 May;10(10):3205-3213. doi: 10.1002/cam4.3887. Epub 2021 May 1.
The incidence of endometrial cancer has tended to increase in recent years. However, competing risk nomogram combining comprehensive factors for endometrial cancer patients treated with hysterectomy is still scarce. Therefore, we aimed to build a competing risk nomogram predicting cancer-specific mortality for endometrial cancer patients treated with hysterectomy.
Patients diagnosed with endometrial cancer between 2010 and 2012 were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database. Competing risk model was performed to select prognostic variables to build the competing risk nomogram to predict the cumulative 3- and 5-year incidences of endometrial cancer-specific mortality. Harrell's C-index, receiver operating characteristic (ROC) curve, and calibration plot were used in the internal validation. And decision curve analysis was applied to evaluate clinical utility.
A total of 10,447 patients were selected for analysis. The competing risk nomogram identified eight prognostic variables, including age at diagnosis, race, marital status at diagnosis, grade, histology, tumor size, FIGO stage, and number of regional nodes positive. The C-index of the competing risk nomogram was 0.857 (95% confidence interval [CI]: 0.854-0.859), and the calibration plots were adequately fitted. When the threshold probabilities were between 1% and 57% for 3-year prediction and between 2% and 67% for 5-year prediction, the competing risk nomogram was of good clinical utility.
A competing risk nomogram for endometrial cancer patients treated with hysterectomy was successfully built and internally validated. It was an accurately predicted and clinical useful tool, which could play an important role in consulting and health care management of endometrial cancer patients.
近年来，子宫内膜癌的发病率呈上升趋势。然而，对于接受子宫切除术治疗的子宫内膜癌患者，结合综合因素的竞争风险列线图仍然缺乏。因此，我们旨在建立一个预测接受子宫切除术治疗的子宫内膜癌患者癌症特异性死亡率的竞争风险列线图。
从监测、流行病学和最终结果（SEER）数据库中提取 2010 年至 2012 年间诊断为子宫内膜癌的患者。采用竞争风险模型选择预后变量，构建竞争风险列线图，预测子宫内膜癌特异性死亡率的 3 年和 5 年累积发生率。内部验证采用 Harrell 的 C 指数、接受者操作特征（ROC）曲线和校准图。决策曲线分析用于评估临床实用性。
共选择了 10447 例患者进行分析。竞争风险列线图确定了 8 个预后变量，包括诊断时的年龄、种族、诊断时的婚姻状况、分级、组织学、肿瘤大小、FIGO 分期和阳性区域淋巴结数。竞争风险列线图的 C 指数为 0.857（95%置信区间[CI]：0.854-0.859），校准图拟合良好。当 3 年预测的阈值概率在 1%至 57%之间，5 年预测的阈值概率在 2%至 67%之间时，竞争风险列线图具有良好的临床实用性。
成功建立并内部验证了接受子宫切除术治疗的子宫内膜癌患者的竞争风险列线图。它是一种准确预测和具有临床实用性的工具，可在咨询和子宫内膜癌患者的医疗保健管理中发挥重要作用。
