Department of Gynecology Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, Anhui, China.
Cancer Med. 2024 May;13(10):e7216. doi: 10.1002/cam4.7216.
BACKGROUND: To find the factors impacting overall survival (OS) prognosis in patients with endometrioid endometrial carcinoma (EEC) and adenocarcinoma and to establish a nomogram model to validate the 2023 International Federation of Obstetrics and Gynecology (FIGO) staging system for endometrial cancer. METHODS: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) training cohort. An independent validation cohort was obtained from the First Affiliated Hospital of Anhui Medical University between 2008 and 2023. Cox regression analysis identified independent prognostic factors for OS in EEC and adenocarcinoma patients. A nomogram predicting OS was developed and validated utilizing the C-index, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). The relationship between the tumor grade and prognosis of EEC and adenocarcinoma was quantified using net reclassification improvement (NRI), propensity score matching (PSM), and Kaplan-Meier curves. RESULTS: Cox regression analysis identified age, race, marital status, tumor grade, tumor stage, tumor size, and chemotherapy as independent prognostic factors for OS. A nomogram for predicting OS was developed based on these factors. The C-indexes for the OS nomogram was 0.743 and 0.720 for the SEER training set and external validation set, respectively. The area under the ROC (AUC) for the OS nomogram was 0.755, 0.757, and 0.741 for the SEER data subsets and 0.844, 0.719, and 0.743 for the external validation subsets. Calibration plots showed high concordance between the nomogram-predicted and observed OS. DCA also demonstrated the clinical utility of the OS nomogram. NRI, PSM, and survival analyses revealed that tumor grade was the most important histopathological factor for EEC and adenocarcinoma prognosis. CONCLUSION: Seven independent prognostic variables for the OS of patients with EEC and adenocarcinoma were identified. The established OS nomogram has good predictive ability and clinical utility and validates the 2023 endometrial cancer FIGO staging system.
背景：为了找到影响子宫内膜样腺癌（EEC）和腺癌患者总生存（OS）预后的因素，并建立一个列线图模型来验证 2023 年国际妇产科联合会（FIGO）子宫内膜癌分期系统。 方法：数据来自监测、流行病学和最终结果（SEER）培训队列。2008 年至 2023 年期间，从安徽医科大学第一附属医院获得了一个独立的验证队列。Cox 回归分析确定了 EEC 和腺癌患者 OS 的独立预后因素。利用 C 指数、校准曲线、接受者操作特征（ROC）曲线和决策曲线分析（DCA）开发和验证了预测 OS 的列线图。通过净重新分类改善（NRI）、倾向评分匹配（PSM）和 Kaplan-Meier 曲线来量化肿瘤分级与 EEC 和腺癌预后的关系。 结果：Cox 回归分析确定年龄、种族、婚姻状况、肿瘤分级、肿瘤分期、肿瘤大小和化疗是 OS 的独立预后因素。根据这些因素开发了一个预测 OS 的列线图。SEER 训练集和外部验证集的 OS 列线图的 C 指数分别为 0.743 和 0.720。OS 列线图的 ROC 曲线下面积（AUC）分别为 0.755、0.757 和 0.741，SEER 数据集和外部验证数据集的 AUC 分别为 0.844、0.719 和 0.743。校准图显示列线图预测的 OS 与观察到的 OS 之间具有高度一致性。DCA 也表明了 OS 列线图的临床实用性。NRI、PSM 和生存分析表明，肿瘤分级是 EEC 和腺癌预后最重要的组织病理学因素。 结论：确定了影响 EEC 和腺癌患者 OS 的七个独立预后变量。建立的 OS 列线图具有良好的预测能力和临床实用性，并验证了 2023 年子宫内膜癌 FIGO 分期系统。
Int J Gynaecol Obstet. 2023-8
Eur Rev Med Pharmacol Sci. 2022-11
Front Endocrinol (Lausanne). 2022
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