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. 2015 Aug;40(6):1761-8.
doi: 10.1007/s00261-014-0337-0.

Preoperative CT-based nomogram for predicting overall survival in women with non-endometrioid carcinomas of the uterine corpus

Yulia Lakhman  1 , Derya Yakar, Debra A Goldman, Seth S Katz, Hebert A Vargas, Maura Miccò, Junting Zheng, Chaya S Moskowitz, Robert A Soslow, Hedvig Hricak, Nadeem R Abu-Rustum, Evis Sala
Affiliations

Preoperative CT-based nomogram for predicting overall survival in women with non-endometrioid carcinomas of the uterine corpus

Yulia Lakhman et al. Abdom Imaging. 2015 Aug.

Abstract

Purpose: To develop a preoperative CT-based nomogram for predicting overall survival (OS) in patients with non-endometrioid carcinomas of the uterine corpus.

Methods: Waiving informed consent, the institutional review board approved this HIPAA-compliant, retrospective study of 193 women with histopathologically proven uterine papillary serous carcinomas (UPSC), uterine clear cell carcinomas (UCCC), and uterine carcinosarcomas (UCS) who underwent primary surgical resection between May 1998 and December 2011, and had a preoperative CT ≤ 6 weeks before surgery. All CT scans were reviewed for local or/and regional tumor extent, presence of pelvic or/and para-aortic adenopathy, and presence of distant metastases. Univariate survival analysis was performed using log-rank test and Cox regression. Variables shown significant by the univariate analysis were evaluated with the multivariable Cox regression analysis and the results were used to create a nomogram for predicting OS. The predictive accuracy of the nomogram was assessed with the concordance probability index (c-index) and a 3-year calibration plot.

Results: Mean patient age was 67.2 years (range 49.0-85.9); histologies included UPSC (n = 116), UCCC (n = 27), and UCS (n = 50). Median follow-up was 38.1 months (0.9-168.5 months). At multivariate analysis, patient age, ascites, and omental implants on CT were significant adverse predictors of OS and were used to build the nomogram. Concordance index for the nomogram was 0.640 ± 0.028.

Conclusion: We developed a nomogram with a good concordance probability at predicting OS based on readily available pretreatment clinical and imaging characteristics. This preoperative nomogram has the potential to improve initial treatment planning and patient counseling.

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Conflict of interest statement

There are no conflicts to disclose.

Figures

Figure 1
Figure 1
(A) Transverse and (B) sagittal contrast-enhanced CT images obtained in a 51-year-old woman with clear cell carcinoma of the uterine corpus demonstrate bulky endometrial tumor with deep myometrial invasion (arrow), dilation of the endocervical canal by the tumor and irregular interphase between the tumor and cervical stroma (arrowhead). (C) Transverse and (D) coronal contrast-enhanced CT images performed in a 49-year-old woman with clear cell carcinoma of the uterine corpus demonstrates deeply invasive tumor including frank cervical stromal invasion (arrowhead).
Figure 2
Figure 2. CT-based preoperative nomogram for predicting overall survival
For each patient, find out the value of each predictor and read off the number from “Points” located on the top axis, then add the points of all predictors and locate it on the “Total Points” axis. The 3-year and the 5-year survival probabilities are the values intersected by a line drawn vertically from the total points.
Figure 3
Figure 3
Calibration plot for the nomogram
See this image and copyright information in PMC

Comment in

  • Commentary.
    Johnson CD, Balch CM. Johnson CD, et al. Abdom Radiol (NY). 2016 Feb;41(2):391. doi: 10.1007/s00261-015-0625-3. Abdom Radiol (NY). 2016. PMID: 26826085 No abstract available.

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