Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 17 Qihelou Street, Dongcheng District, Beijing, 100006, China.
J Cancer Res Clin Oncol. 2023 Nov;149(16):14475-14492. doi: 10.1007/s00432-023-05174-3. Epub 2023 Aug 12.
To investigate the prognostic indicators, develop and verify nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) in elderly patients with uterine serous carcinoma (USC).
Data of eligible USC patients aged ≥ 65 years from 2004 to 2015 in the Surveillance, Epidemiology and End Results (SEER) database were collected for retrospective analysis. X-tile software was used to assess the optimal cut-off values. Univariate and multivariate Cox regression analyses were performed to explore the prognostic factors. Nomograms were developed to predict the probability of 1-, 3- and 5-year OS and CSS. Concordance indexes (c-index), receiver operating characteristic analysis and calibration curves were used to evaluate the model. Decision curve analysis (DCA) was introduced to examine the clinical value of the models.
Age, Federation International of Gynecology and Obstetrics stage, N stage, tumor size, number of lymph nodes resected, and adjuvant therapy were independent prognostic factors for OS and CSS. The C-indexes were 0.736 (OS), 0.754 (CSS) in the training set and 0.731 (OS), 0.759 (CSS) in the validation set. The area under the curve (AUCs) of OS and CSS for 1-, 3-, and 5-years all exceeded 0.75. The calibration plots for the probability of survival were in good agreement. As shown in DCA curves, the nomograms showed better discrimination power and higher net benefits than the 6th American Joint Committee on Cancer staging system.
The nomograms constructed based on prognostic risk factors could individually predict the prognosis of elderly USC patients and provide a reference for clinical decision-making.
探讨预测老年子宫内膜浆液性癌（USC）患者总生存（OS）和癌症特异性生存（CSS）的预后指标，建立并验证列线图。
回顾性分析 2004 年至 2015 年 SEER 数据库中年龄≥65 岁的 USC 患者数据。使用 X-tile 软件评估最佳截断值。采用单因素和多因素 Cox 回归分析探讨预后因素。建立预测 1、3 和 5 年 OS 和 CSS 概率的列线图。采用一致性指数（c-index）、接受者操作特征分析和校准曲线评估模型。引入决策曲线分析（DCA）评估模型的临床价值。
年龄、国际妇产科联盟分期、N 分期、肿瘤大小、切除的淋巴结数量和辅助治疗是 OS 和 CSS 的独立预后因素。训练集的 C 指数分别为 0.736（OS）和 0.754（CSS），验证集的 C 指数分别为 0.731（OS）和 0.759（CSS）。OS 和 CSS 的 1、3 和 5 年 AUC 均超过 0.75。生存概率的校准图吻合良好。DCA 曲线显示，与第 6 版 AJCC 分期系统相比，列线图具有更好的判别能力和更高的净获益。
基于预后风险因素构建的列线图可单独预测老年 USC 患者的预后，并为临床决策提供参考。
