Risk-scoring system for the individualized prediction of lymphatic dissemination in patients with endometrioid endometrial cancer

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• 作者：M.M. AlHilli ; K.C. Podratz ; S.C. Dowdy ; J.N. Bakkum-Gamez ; A.L. Weaver ; M.E. McGree ; G.L. Keeney ; W.A. Cliby ; A. Mariani
• 关键词：Risk-Scoring Model ; Endometrial Cancer ; Nomogram
• 刊名：Gynecologic Oncology
• 出版年：2013
• 出版时间：October, 2013
• 年：2013
• 卷：131
• 期：1
• 页码：103-108
• 全文大小：402 K

文摘

class=""h4"">Objective

To develop a risk-scoring system (RSS) for the prediction of lymphatic dissemination after hysterectomy in endometrioid endometrial carcinoma (EC).

class=""h4"">Methods

Patients who underwent surgery from 1/1/1999-12/31/2008 were evaluated. Patients with non-endometrioid histology, stage IV with macroscopic extrauterine disease, or receiving adjuvant therapy (excluding brachytherapy) without pelvic and/or paraaortic (P/PA) lymphadenectomy (LND) were excluded. Lymph node dissemination was defined as nodal metastasis when P/PA LND was performed or P/PA lymph node recurrence after negative LND or when LND was not performed. Logistic regression analysis was used to identify predictors for lymphatic dissemination and develop a RSS and nomogram. The RSS was assessed for calibration and verified for discrimination.

class=""h4"">Results

Overall, 883 patients were assessed of which 521 (59.0 % ) underwent P/PA LND and 57 (10.9 % ) had positive lymph nodes. Of patients who did not undergo P/PA LND (N = 362) or had negative nodes (N = 464), 10 (1.2 % ) patients had P/PA lymph node recurrence. Myometrial invasion, tumor diameter (TD), FIGO grade, cervical stromal invasion and lymphovascular space invasion were significant on univariable analysis. All preceding variables were included in a multivariable logistic model. A parsimonious model and an alternative full model not including TD were considered. The full model with TD (illustrated in nomogram) had the highest predictive ability (concordance index 0.88).

class=""h4"">Conclusion

Our RSS allows accurate quantification of the probability of lymphatic dissemination and can be used as an adjunct to clinical decision-making after hysterectomy in the absence of staging. TD is an important component of the RSS and should be routinely assessed.