An Externally Validated Nomogram for Predicting Lymph Node Metastasis of Presumed Stage I and II Endometrial Cancer

Abstract

Background: Optimal management for endometrial cancer in patients with clinically negative lymph nodes is still under debate. Several prediction models for lymphatic dissemination of early-stage endometrial cancer have been developed. However, external validation is rare, and decision curve analysis has hardly been applied for these models.Objective: To develop and validate a nomogram to predict lymph node metastasis of presumed stage I and II endometrial cancer.Study Design: The prediction nomogram was developed by using multivariable logistic regression with data for 700 EC patients who underwent initial surgery from 2006 to 2017 at Peking University People's Hospital (training dataset), Beijing. External validation was performed in 727 eligible patients from Fudan University Shanghai Cancer Center (validation dataset), Shanghai.Results: For the 700 women in the training dataset, the lymph node metastasis rate was 8.0% (56/700). Lymphovascular space invasion, histological grade, cervical stromal invasion, and myometrial invasion were independent prognostic factors in the training dataset. We generated a nomogram based on these pathological factors. To determine the clinical usefulness of our nomogram, we compared it with the Mayo criteria. For our nomogram, the area under the receiver operating characteristic curve (AUC) was 0.85 as compared with 0.63 for the Mayo criteria. In the validation dataset, the AUC was 0.78 as compared with 0.57 for the Mayo criteria. The nomogram was well-calibrated in both the training and validation datasets. At a 10% probability threshold, our nomogram decreased almost 29 unnecessary lymphadenectomies per 100 patients than the Mayo criteria without missing more metastatic disease.Conclusion: We developed a nomogram to predict lymph node metastasis in patients with early-stage endometrial cancer in China. This prediction model may help clinicians in decision-making for patients with early-stage endometrial cancer, especially for the patient with incomplete surgery, reducing overtreatment, and medical costs.

<p>Increased Serum Calcium Level Promotes the Risk of Lymph Node Metastasis in Endometrial Cancer</p>

“…One recent study constructed a nomogram for predicting the overall survival and found the nomogram was more accurate than the Mayo criteria. 14 Other studies focused on a risk matrix model to identify high-risk parameters necessitating lymphadenectomy and to decide the risks and benefits of lymphadenectomy. 15 A long-term argument against routine lymph node dissection was that the procedure could cause several complications such as bowel obstruction, deep venous thrombus and chronic lymphedema.…”

Nomogram for Predicting Recurrence-Free Survival in Chinese Women with Endometrial Cancer after Initial Therapy: External Validation

“…Individualized mathematical nomograms have been widely adopted as auxiliary tools to guide clinical decision making in medical fields [11][12][13][14]. In 2014, AlHilli et al developed nomograms stratified histologically to predict the overall survival of EC patients [10].…”

Development and validation of prognostic factors for lymph node metastasis in endometrial cancer: A SEER analysis

“…A previous study from our institute also revealed that cervical stromal invasion is an independent risk factor for LNM (in addition to LVSI, tumor grade, and myometrial invasion) in EC patients and may have an important role in predicting LNM. [28] . Another study also suggested that cervical stromal invasion was useful in estimating LNM risk for EC patients and directing therapeutic strategies [29] .…”