Chen Shuya, Deng Yunhan, Zhai Yan, Zhan Yang, Li Xue, Wang Jiandong, Bai Huimin
Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China.
Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
Int J Womens Health. 2023 Apr 11;15:545-557. doi: 10.2147/IJWH.S406381. eCollection 2023.
To reveal the clinical status and construct a predictive prognostic model for patients with uterine leiomyosarcoma (uLMS) at International Federation of Gynecology and Obstetrics (FIGO) stage I.
The medical records of patients with stage I uLMS during the study period were retrospectively reviewed. Multiple imputation, Martingale residuals and restricted cubic spline were used for data processing. Univariate and multivariate analyses were used to determine independent prognostic factors. The Schoenfeld individual test was used to verify the proportional hazards (PH) assumption. The predictive ability of the nomogram was validated internally.
Ultimately, 102 patients were included. The median age at diagnosis was 51 years old. During the medium follow-up time of 68 months, 55 (53.9%) patients developed recurrence. The median recurrence interval was 32 months. The most common metastatic site was the lung (27 cases). Eventually, 38 (37.3%) patients died of uLMS. The 3-year and 5-year overall survival rates were 66.0% and 52.0%, respectively. Age at diagnosis >49 years, larger tumor size, MI>10/10HPF, presence of LVSI and Ki-67 labeling index (LI) >25% (P=0.0467, 0.0077, 0.0475, 0.0294, and 0.0427, respectively) were independent prognostic factors. The PH assumption remained inviolate. The concordance index was 0.847, the area under the time-dependent receiver operating characteristic curve surpassed 0.7, and the calibration curve showed gratifying consistency.
Age at diagnosis, tumor size, MI, LVSI, and Ki-67 LI were identified as independent prognostic factors for stage I uLMS. This prognostic nomogram would provide personalized assessment with superior predictive performance.
揭示国际妇产科联盟（FIGO）I期子宫平滑肌肉瘤（uLMS）患者的临床状况并构建预测预后模型。
回顾性分析研究期间I期uLMS患者的病历。采用多重填补、鞅残差和限制性立方样条进行数据处理。单因素和多因素分析用于确定独立预后因素。采用Schoenfeld个体检验验证比例风险（PH）假设。内部验证列线图的预测能力。
最终纳入102例患者。诊断时的中位年龄为51岁。在68个月的中位随访时间内，55例（53.9%）患者出现复发。中位复发间隔为32个月。最常见的转移部位是肺（27例）。最终，38例（37.3%）患者死于uLMS。3年和5年总生存率分别为66.0%和52.0%。诊断时年龄>49岁、肿瘤体积较大、核分裂象>10/10HPF、存在淋巴管血管浸润（LVSI）以及Ki-67标记指数（LI）>25%（分别为P = 0.0467、0.0077、0.0475、0.0294和0.0427）是独立预后因素。PH假设仍然成立。一致性指数为0.847，时间依赖性受试者工作特征曲线下面积超过0.7，校准曲线显示出良好的一致性。
诊断时年龄、肿瘤大小、核分裂象、LVSI和Ki-67 LI被确定为I期uLMS的独立预后因素。该预后列线图将提供具有卓越预测性能的个性化评估。
