A Novel Predictive Tool for Determining the Risk of Early Death From Stage IV Endometrial Carcinoma: A Large Cohort Study

Abstract

Background: Endometrial carcinoma is a common gynecological malignancy. Stage IV endometrial carcinoma is associated with a high risk of early death; however, there is currently no effective prognostic tool to predict early death in stage IV endometrial cancer.

Methods: Surveillance, Epidemiology, and End Results (SEER) data from patients with stage IV endometrial cancer registered between 2004 and 2015 were used in this study. Important independent prognostic factors were identified by univariate and multivariate logistic regression analyses. A nomogram of all-cause and cancer-specific early deaths was constructed using relevant risk factors such as tumor size, histological grade, histological classification, and treatment (surgery, radiotherapy, chemotherapy).

Results: A total of 2,040 patients with stage IV endometrial carcinoma were included in this study. Of these, 299 patients experienced early death (≤3 months) and 282 died from cancer-specific causes. The nomogram of all-cause and cancer-specific early deaths showed good predictive power and clinical practicality with respect to the area under the receiver operating characteristic curve and decision curve analysis. The internal validation of the nomogram revealed a good agreement between predicted early death and actual early death.

Conclusions: We developed a clinically useful nomogram to predict early mortality from stage IV endometrial carcinoma using data from a large cohort. This tool can help clinicians screen high-risk patients and implement individualized treatment regimens.

Keywords: SEER database; early death; endometrial carcinoma; nomograms; prognosis.

Figure 1

The flowchart of patient selection.

Figure 2

The appropriate cutoff values of age and tumor size was assessed by X-tile analysis. (A, B) The appropriate cutoff values of age were 55 and 74 years. (C, D) The appropriate cutoff values of tumor size were 59 and 105 mm.

Figure 3

The nomograms of early death in patients with stage IV endometrial carcinoma. (A) |The all-cause early death. (B) The cancer-specific early death.

Figure 4

The receiver operating characteristic (ROC) curve for nomogram. (A) The all-cause early death. (B) The cancer-specific early death. AUC, area under the curve; ROC, receiver operating characteristic.

Figure 5

The decision curve analysis (DCA) curve for nomogram. (A) The all-cause early death. (B) The cancer-specific early death.

Figure 6

Internal verification plots of nomogram calibration curves by k-fold cross-validation (k =10). (A) The all-cause early death. (B) The cancer-specific early death.