基于 SEER 数据库和中国两个中心的子宫内膜样卵巢癌的临床特征和预后分析。

An analysis of clinical characteristics and prognosis of endometrioid ovarian cancer based on the SEER database and two centers in China.

机构信息

Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.

Department of Gynecologic Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.

出版信息

BMC Cancer. 2023 Jul 1;23(1):608. doi: 10.1186/s12885-023-11048-1.

DOI:10.1186/s12885-023-11048-1

PMID:37391693

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10314552/

Abstract

PURPOSE

To assess the clinical characteristics and the risk factors related to the unfavorable prognosis of endometrioid ovarian carcinoma (EOVC) based on data from the Surveillance, Epidemiology, and End Results (SEER) database and two clinical centers in China.

METHODS

Data were extracted from the SEER database and two clinical centers in China (2010 ~ 2021), 884 cases and 87 patients with EOVC were selected, respectively. Overall survival (OS) and progression-free survival (PFS) were compared among the different groups using Kaplan-Meier analysis. The Cox proportional-hazards model was used to identify independent prognostic factors related to EOVC. A nomogram was constructed based on the risk factors of the SEER database affecting prognosis and the discrimination and calibration of the nomogram were evaluated by C-index and calibration curves.

RESULTS

The average age at diagnosis of patients with EOVC in the SEER database and two centers in China was 55.77 ± 12.40 years and 47.14 ± 11.50 years, 84.7% and 66.6% of them were diagnosed at FIGO stage I ~ II, respectively. In the SEER database, age over 70 years, advanced FIGO stage, tumor grade 3, only unilateral salpingo-oophorectomy were independent risk factors of unfavorable prognosis. In two clinical centers in China, 27.6% of EOVC patients were diagnosed with synchronous endometriosis. Advanced FIGO stage, HE4 > 179 pmol/L and bilateral ovarian involvement significantly correlated with poor OS and PFS in Kaplan-Meier analysis. Body mass index (BMI) < 19.34 kg/m was an independent risk factor relating to OS and PFS. Additionally, C-index of internal and external verification for the nomogram were 0.812 and 0.754 respectively, revealing good accuracy and clinical applicability.

CONCLUSIONS

Most patients were diagnosed at early stage, low grade and had better prognosis. Asian/Pacific Islander and Chinese diagnosed with EOVC were more likely to be younger than whites and blacks. Age, tumor grade and FIGO stage (SEER database) and BMI (two centers) are independent prognostic factors. HE4 appears to be more valuable in prognostic assessment compared with CA125. The nomogram had good discrimination and calibration for predicting prognosis, providing a convenient and reliable tool for clinical decision-making for patients with EOVC.

摘要

目的

基于美国监测、流行病学和最终结果（SEER）数据库和中国两个临床中心的数据，评估子宫内膜样卵巢癌（EOVC）的临床特征和与不良预后相关的危险因素。

方法

从 SEER 数据库和中国两个临床中心（2010 年至 2021 年）提取数据，分别选择 884 例和 87 例 EOVC 患者。采用 Kaplan-Meier 分析比较不同组之间的总生存期（OS）和无进展生存期（PFS）。采用 Cox 比例风险模型确定与 EOVC 相关的独立预后危险因素。根据影响预后的 SEER 数据库危险因素和列线图的区分度和校准度，构建列线图，并通过 C 指数和校准曲线进行评估。

结果

SEER 数据库和中国两个中心的 EOVC 患者的平均诊断年龄分别为 55.77±12.40 岁和 47.14±11.50 岁，分别有 84.7%和 66.6%的患者诊断为 FIGO Ⅰ~Ⅱ期。在 SEER 数据库中，年龄超过 70 岁、晚期 FIGO 分期、肿瘤分级 3 级、仅单侧附件切除术是不良预后的独立危险因素。在中国两个临床中心中，27.6%的 EOVC 患者同时诊断为子宫内膜异位症。在 Kaplan-Meier 分析中，晚期 FIGO 分期、HE4>179 pmol/L 和双侧卵巢受累与 OS 和 PFS 不良显著相关。体质指数（BMI）<19.34 kg/m2 是与 OS 和 PFS 相关的独立危险因素。此外，内部和外部验证的列线图 C 指数分别为 0.812 和 0.754，显示出良好的准确性和临床适用性。

结论

大多数患者在早期被诊断，分级较低，预后较好。亚洲/太平洋岛民和中国的 EOVC 患者比白人和黑人更年轻。年龄、肿瘤分级和 FIGO 分期（SEER 数据库）和 BMI（两个中心）是独立的预后因素。HE4 在预后评估中似乎比 CA125 更有价值。该列线图对预测预后具有良好的区分度和校准度，为 EOVC 患者的临床决策提供了一种方便可靠的工具。