Nomograms to predict isolated loco-regional or distant recurrence among women with uterine cancer

• Published in: Gynecologic oncology 2012-06, Vol.125 (3), p.520-525
• Main Authors: Kondalsamy-Chennakesavan, Srinivas, Yu, Changhong, Kattan, Michael W, Leung, Yee, Sykes, Peter, Nascimento, Marcelo, Nicklin, James, Perrin, Lewis, Crandon, Alex, Chetty, Naven, Land, Russell, Garrett, Andrea, Obermair, Andreas
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Hematology, Oncology and Palliative Medicine; Humans; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Nomograms; Obstetrics and Gynecology; Predictive Value of Tests; Recurrence; Risk Factors; Risk-prediction; Uterine cancer; Uterine Neoplasms - epidemiology; Uterine Neoplasms - pathology
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2012.02.022

Abstract Objective While there is ample literature on prognostic factors for uterine cancer, currently there are nomeans to estimate an individual's risk for recurrence or to differentiate the risk of loco-regional recurrence from distant recurrence. We addressed this gap by developing nomograms to individualize the risk of recurrence. Methods A total of 2097 consecutive patients who underwent primary surgery between 1997 and 2007 were included. Sixteen covariates were evaluated for their prognostic significance and modeled using multivariable competing risks regression to predict three-year outcomes as part of a nomogram. Each covariate in the nomogram is assigned a value, and a sum of these values form the overall risk score from which three-year incidence probabilities can be predicted for each individual. Predictive accuracy was assessed with concordance index and then corrected for optimism. Results The median follow-up time (inter-quartile range, IQR) was 50.0 (28.3–77.5) months and 221 patients developed a recurrence (127 patients with isolated loco-regional recurrence, 94 patients with distant recurrence). The nomograms included the following covariates: age at diagnosis, FIGO stage (2009), grade, lymphovascular invasion, histological type, depth of myometrial invasion, and peritoneal cytology. Concordance indices for isolated loco-regional and distant recurrences were 0.73 and 0.86, respectively. Conclusions Our nomograms quantify an individual patient's risk of isolated loco-regional and distant recurrence, using factors that are routinely collected. They may assist clinicians to assess an individual's prognosis, individualize treatment and also assist in the risk stratification in prospective randomized clinical trials evaluating the effectiveness of treatments for uterine cancer.