Nomograms for Predicting Overall and Cancer-Specific Survival Among Second Primary Endometrial Cancer in Primary Colorectal Carcinoma Patients

Abstract

Endometrial cancer (EC) is one of the most frequent gynecologic cancers, approximately 20% of patients are regarded as high-risk with poor prognosis. However, more details of patients with second primary endometrial cancer (SPEC) after colorectal cancer (CRC) remain poorly understood.We therefore purposed to construct two nomograms to predict 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) rates to facilitate clinical application. Nomograms for predicting OS and CSS were constructed and validated. The receiver operating characteristic curves, calibration plot, decision curve analysis, C-index, net reclassification improvement, and integrated discrimination improvement were applied to evaluate the predictive performance. Finally, the Prognostic index was calculated and used for risk stratification of Kaplan-Meier survival analysis based on different treatment options. Nomograms of OS and CSS were formulated based on the independent prognostic factors utilizing the training set. The 3- and 5- years of OS nomogram demonstrated good discrimination (AUC = 0.840 and 0.829, respectively), well-calibrated power, and excellent clinical effectiveness. Our nomograms of predicting OS and CSS had a concordance index of 0.801 and 0.866 compared with 0.676 and 0.746 for the AJCC staging system, and more importantly, demonstrated a better forecast accuracy. Chemoradiotherapy displayed a significant survival benefit in the high-risk groups, but proceeding to surgery plus chemotherapy showed a favorable survival for the low groups based on all patients. We developed and internally validated multivariable models that predict OS and CSS risk of SPEC in patients with a CRC to help clinicians make applicable clinical decisions for patients.