Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
Emergency Department, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
Int J Gynaecol Obstet. 2024 Aug;166(2):707-717. doi: 10.1002/ijgo.15456. Epub 2024 Mar 5.
To evaluate the risk factors for uterine clear-cell carcinoma (UCCC) and construct nomograms predicting 1-, 3-, and 5-year overall survival rates of patients with UCCC.
The demographic and clinical information of 1674 patients diagnosed with UCCC between 2004 and 2015, including age, race, marital status, tumor size, American Joint Committee on Cancer (AJCC) stage, and details of surgery and radiotherapy/chemotherapy, was collected from the Surveillance, Epidemiology, and End Results (SEER) database. After excluding patients with unknown AJCC stage, race, marital status, or lymph node information, 1469 patients remained. Risk factors were determined using univariate and multivariate analyses, and nomograms were developed to predict 1-, 3-, and 5-year overall survival of UCCC. Various indicators were used to evaluate the performance of the nomogram, such as the C-index, net classification improvement (NRI) and decision curve analysis (DCA).
Age, log odds of positive lymph nodes, AJCC stage, surgery status, and chemotherapy status were independent risk factors for UCCC. The C-indexes of the training group and AJCC stage groups were 0.771 and 0.697, respectively. The results for the area under the receiver operating characteristics curve, NRI, and calibration curves indicated that the nomogram had good predictive ability. DCA revealed that the nomogram had greater clinical applicability than AJCC stage alone. Internal validation using the validation cohort also demonstrated that this nomogram had good predictive performance.
A new nomogram comprising a combination of demographic and clinical characteristics provided better survival predictions than the AJCC staging system alone, which will facilitate prognostic assessments and clinical decision-making.
评估子宫透明细胞癌（UCCC）的危险因素，并构建预测 UCCC 患者 1、3 和 5 年总生存率的列线图。
从监测、流行病学和最终结果（SEER）数据库中收集了 2004 年至 2015 年间诊断为 UCCC 的 1674 名患者的人口统计学和临床信息，包括年龄、种族、婚姻状况、肿瘤大小、美国癌症联合委员会（AJCC）分期以及手术和放疗/化疗的详细信息。在排除了 AJCC 分期、种族、婚姻状况或淋巴结信息未知的患者后，有 1469 名患者被纳入研究。使用单因素和多因素分析确定危险因素，并开发列线图预测 UCCC 的 1、3 和 5 年总生存率。使用 C 指数、净分类改善（NRI）和决策曲线分析（DCA）等各种指标评估列线图的性能。
年龄、阳性淋巴结对数优势比、AJCC 分期、手术状态和化疗状态是 UCCC 的独立危险因素。训练组和 AJCC 分期组的 C 指数分别为 0.771 和 0.697。受试者工作特征曲线下面积、NRI 和校准曲线的结果表明，该列线图具有良好的预测能力。DCA 显示，该列线图比 AJCC 分期具有更大的临床适用性。使用验证队列进行内部验证也表明，该列线图具有良好的预测性能。
由人口统计学和临床特征组成的新列线图提供了比 AJCC 分期系统更好的生存预测，这将有助于预后评估和临床决策。
