Wang Cheng, Liang Dongni, Kuang Wei, Sun Huanxin, Kou Yuling, Wang Wei, Zeng Jing
Department of Pathology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
Front Oncol. 2025 Mar 7;15:1567195. doi: 10.3389/fonc.2025.1567195. eCollection 2025.
High-grade endometrial stromal sarcoma (HGESS) is a rare, aggressive malignant tumor that often metastasizes early and is associated with a poor prognosis. This study aimed to develop a nomogram to predict the risk factors for distant metastases and the prognostic factors at the time of initial diagnosis.
Data on patients diagnosed with HGESS from 2010 to 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly divided into the training and validation sets. Univariate and multivariate regression analyses were conducted to identify significant independent risk factors for distant metastases in HGESS patients, and univariate and multivariate Cox regression analyses were used to identify prognostic factors of HGESS patients with distant metastases. The Akaike information criterion (AIC) was used to further refine variables and construct a nomogram for predicting overall survival (OS) of HGESS patients with distant metastases. Two nomograms were developed and evaluated using receiver operating characteristic (ROC) curves, calibration plots, decision curves analysis, and concordance-index (C-index). In addition, Kaplan-Meier (KM) analysis was performed to evaluate OS in both the entire cohort and the metastasis cohort.
A total of 360 HGESS patients were included, of whom 89 patients (24.7%) had distant metastases at initial diagnosis. Risk factors for distant metastases in HGESS patients included race, tumor size, T stage, and N stage. Prognostic factors for distant metastasis in HGESS patients included N stage and systemic therapy. Three variables - age, N stage and systemic therapy - were incorporated to construct the nomogram for predicting prognosis. The C-indexes for the training and validation sets were 0.776 and 0.710, respectively. In the entire cohort, significant differences in median OS were observed for tumor size, Federation International of Gynecology and Obstetrics (FIGO) stage, number of nodes examined, surgery, and radiotherapy. In metastasis cohort, significant differences in median OS were observed for N stage, surgery, chemotherapy, and systemic therapy.
The two nomograms developed in this study accurately predict the occurrence and prognosis of HGESS patients with distant metastases, which may aid clinical decision-making.
高级别子宫内膜间质肉瘤（HGESS）是一种罕见的侵袭性恶性肿瘤，常早期发生转移，预后较差。本研究旨在开发一种列线图，以预测初诊时远处转移的危险因素和预后因素。
从监测、流行病学和最终结果（SEER）数据库中提取2010年至2019年诊断为HGESS的患者数据。患者被随机分为训练集和验证集。进行单因素和多因素回归分析，以确定HGESS患者远处转移的显著独立危险因素，并使用单因素和多因素Cox回归分析来确定HGESS远处转移患者的预后因素。采用赤池信息准则（AIC）进一步优化变量，并构建预测HGESS远处转移患者总生存期（OS）的列线图。使用受试者操作特征（ROC）曲线、校准图、决策曲线分析和一致性指数（C-index）开发并评估了两个列线图。此外，进行Kaplan-Meier（KM）分析以评估整个队列和转移队列中的OS。
共纳入360例HGESS患者，其中89例（24.7%）在初诊时发生远处转移。HGESS患者远处转移的危险因素包括种族、肿瘤大小、T分期和N分期。HGESS患者远处转移的预后因素包括N分期和全身治疗。纳入年龄、N分期和全身治疗三个变量构建预测预后的列线图。训练集和验证集的C-index分别为0.776和
