Comparison of Risk Stratification Systems for Predicting Clinical Outcomes in Patients with Endometrial Carcinoma

• Published in: Hong Kong journal of radiology : HKJR = Xianggang fang she ke yi xue za zhi 2020-06, Vol.23 (2), p.84-92
• Main Authors: Yip, CYY, Pang, H, Chan, LLK, Wu, PY, Chang, ATY, Soong, SI
• Format: Article
• Language: English
• Subjects: Abdomen; Chemotherapy; Classification; Clinical outcomes; Endometrial cancer; Gynecology; Magnetic resonance imaging; Medical prognosis; Oncology; Pelvis; Radiation therapy; Risk factors; Statistical analysis; Survival analysis
• ISSN: 2223-6619; 2307-4620
• DOI: 10.12809/hkjr2017015

Objectives We sought to compare three risk stratification systems (RSSs) in terms of ability in predicting recurrence and survival in endometrial cancer: the joint 2010 International Federation of Gynecology and Obstetrics/American Joint Committee on Cancer (FIGO/AJCC) staging system, the 2013 European Society for Medical Oncology (ESMO) classification system, and the 2016 European Society for Medical Oncology, European Society of Gynaecological Oncology and European Society for Radiotherapy & Oncology (ESMO-ESGO-ESTRO) classification system. Methods Data of patients with FIGO stage I to III endometrial carcinoma requiring adjuvant oncological treatment from 1 January 2005 to 31 December 2014 in a single institution in Hong Kong were retrospectively reviewed. The three systems were evaluated in terms of accuracy of predicting recurrence, cancer-specific survival, and overall survival using Harrell’s concordance index (C-index). Results Data from 128 patients were analysed. Recurrences occurred in 22 (17%) and cancer-related deaths occurred in 18 (14%). The joint 2010 FIGO/AJCC staging system had the highest C-index of 0.75 (95% confidence interval [CI] = 0.65-0.86) for recurrence and 0.76 for overall survival (95% CI = 0.65-0.88). In terms of predicting cancer-specific survival, the ESMO-ESGO-ESTRO subgroup classification had the highest C-index of 0.80 (95% CI = 0.58-1.00). Conclusion We demonstrated the discriminative abilities of the joint 2010 FIGO/AJCC staging system, the ESMO classification, and the ESMO-ESGO-ESTRO classification in predicting disease-free survival, cancer-specific survival, and overall survival using Harrell’s C-index. The ESMO-ESGO-ESTRO classification has potential in guiding clinical decision making and patients’ risk assignment in studies. Integration of molecular classification may represent the way forward in classifying endometrial carcinoma and instituting personalised treatment algorithms.