A nomogram for predicting overall survival of women with endometrial cancer following primary therapy: Toward improving individualized cancer care

Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Gynecologic Oncology (Impact Factor: 3.77). 12/2009; 116(3):399-403. DOI: 10.1016/j.ygyno.2009.11.027
Source: PubMed

ABSTRACT Traditionally we have relied mainly on final FIGO stage to estimate overall oncologic outcome in endometrial cancer patients. However, it is well known that other patient factors may play equally important roles in outcome. Our objective was to develop a clinically useful nomogram in the hope of providing a more individualized and accurate estimation of overall survival (OS) following primary therapy.
Using a prospectively maintained endometrial cancer database, 1735 patients treated between 1993 and 2008 were analyzed. Characteristics known to predict OS were collected. For each patient, points were assigned to each of these 5 variables. A total score was calculated. The association between each predictor and the outcome was assessed by multivariable modeling. The corresponding 3-year OS probabilities were then determined from the nomogram.
The median age was 62 years (range, 25-96). Final grade included: G1 (471), G2 (622), G3 (634), and missing (8). Stage included: IA (501), IB (590), IC (141), IIA (36), IIB (75), IIIA (116), IIIB (6), IIIC (135), IVA (7), and IVB (128). Histology included: adenocarcinoma (1376), carcinosarcoma (100), clear cell (62), and serous (197). Median follow-up for survivors was 29.2 months (0-162.2 months). Concordance probability estimator for the nomogram is 0.746+/-0.011.
We developed a nomogram based on 5 easily available clinical characteristics to predict OS with a high concordance probability. This nomogram incorporates other individualized patient variables beyond FIGO stage to more accurately predict outcome. This new tool may be useful to clinicians in assessing patient risk when deciding on follow-up strategies.

13 Reads
  • Source
    • "We found that prognostic factors are statistically balanced between the three groups, except for the mitotic index (N 20 mitosis) and stage II that are statistically more frequent in the radiotherapy group (Table 3). Mitotic index resulted to be the most significant parameter – as reported on uterine prognostic nomograms [30] [31], and specifically on the ULMS ones, developed from Memorial Sloan-Kettering Cancer Center [32] [33] – followed by age and tumor size. The presence of more unfavorable prognostic factors , in particular the number of mitosis (N 20 × 10 HPF), that was described as an independent prognostic factor in the multivariate analysis of our study, suggests that the worse prognosis of women treated with adjuvant RT (Tables 4 and 5) may be related, at least partially, to the histopathological characteristics rather than the radiotherapy itself. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: About 50-60% of patients with stage I-II uterine leiomyosarcoma (ULMS), primarily treated with surgery, relapse and die from progressive disease. In this retrospective study we describe the impact of adjuvant chemotherapy in this subset of patients. Methods: 140 women treated from 1976 to 2011 were included in the study. Univariate and multivariate analysis were used to test the association of clinical features and adjuvant treatments with overall survival (OS) and disease-free survival (DFS). Results: 62 women did not receive any further treatment after hysterectomy, 14 had radiotherapy (RT), 52 chemotherapy and 12 chemo-radiotherapy. Chemotherapy based on doxorubicin and ifosfamide combination was used in 54 cases. After a median follow-up of 63months, 87 women (62%) have relapsed, and 62 (44%) have died. The vast majority of patients who relapsed had distant recurrences (72%). The 5year median DFS and OS were 43% and 64% respectively. After 5years of follow up 68.7% of women treated with chemotherapy (±RT) vs 65.6% of patients only observed were alive (p=0.521). In the univariate analysis no factors had a statistical impact on DFS, while number of mitosis (>20×10HPF), age (>60years) and adjuvant radiotherapy were found as negative prognostic factors for OS. In the multivariate analysis only mitosis and age remained significant for OS. Conclusion: Adjuvant chemotherapy was not associated with a significant survival benefit and should not be considered as standard of care for patients with stage I-II ULMS until randomized clinical studies will give further information.
    Gynecologic Oncology 06/2014; 133(3). DOI:10.1016/j.ygyno.2014.03.001 · 3.77 Impact Factor
  • Source
    • "Recent advances in therapeutic approaches for EC, coupled with the new 2009 FIGO staging system, have led to an increasing interest in individual prediction and risk calculation (Chun et al, 2006; Abu-Rustum et al, 2010; Bendifallah et al, 2012; "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: To externally validate and assess the robustness of two nomograms to predict the recurrence risk of women with endometrial cancer (EC). Methods: Using an independent, multicentre external patient cohort we assessed the discrimination and calibration of two nomograms – the 3-year isolated loco-regional (ILRR) and distant (DR) recurrence nomograms – in women with surgically treated stage I–III EC. Results: Two hundred and seventy one eligible women were identified from two university hospital databases and the Senti-Endo trial. The median follow-up and initial recurrence time were 38.1 (range: 12–69) and 22.0 (range: 8.3–55) months, respectively. The overall recurrence rate was 13.8% (37 out of 271). Predictive accuracy according to the discrimination was 0.69 (95% CI, 0.58–0.79) and 0.66 (95% CI, 0.60–0.71) for the 3-year ILRR and DR nomograms, respectively. The correspondence between observed recurrence rate and the nomogram predictions suggests a moderate calibration of the nomograms in the validation cohort. Conclusion: The nomograms were externally validated and shown to be partly generalisable to a new and independent patient population. The tools need to be improved by including information on the lymph node status and adjuvant therapies.
    British Journal of Cancer 08/2013; 109(6). DOI:10.1038/bjc.2013.500 · 4.84 Impact Factor
  • Source
    • "Prognostic nomograms have been recently introduced for numerous malignancies, including gynaecologic cancers, to obtain reliable prognostic information tailored to each individual patient (Chi et al, 2008; Abu-Rustum et al, 2010). Several nomograms were shown to compare favourably to traditional staging systems and their use has been suggested in addition to or even as an alternative to disease stage and other established prognosticators (Iasonos et al, 2008; Abu-Rustum et al, 2010). For patients with cervical cancer, a nomogram to predict overall survival (OS) through stages I–IV has not been published so far. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Nomograms are predictive tools that are widely used for estimating cancer prognosis. The aim of this study was to develop a nomogram for the prediction of overall survival (OS) in patients diagnosed with cervical cancer. Methods: Cervical cancer databases of two large institutions were analysed. Overall survival was defined as the clinical endpoint and OS probabilities were estimated using the Kaplan–Meier method. Based on the results of survival analyses and previous studies, relevant covariates were identified, a nomogram was constructed and validated using bootstrap cross-validation. Discrimination of the nomogram was quantified with the concordance probability. Results: In total, 528 consecutive patients with invasive cervical cancer, who had all nomogram variables available, were identified. Mean 5-year OS rates for patients with International Federation of Gynecologists and Obstetricians (FIGO) stage IA, IB, II, III, and IV were 99.0%, 88.6%, 65.8%, 58.7%, and 41.5%, respectively. Seventy-six cancer-related deaths were observed during the follow-up period. FIGO stage, tumour size, age, histologic subtype, lymph node ratio, and parametrial involvement were selected as nomogram covariates. The prognostic performance of the model exceeded that of FIGO stage alone and the model's estimated optimism-corrected concordance probability was 0.723, indicating accurate prediction of OS. We present the prediction model as nomogram and provide a web-based risk calculator ( Conclusion: Based on six easily available parameters, a novel statistical model to predict OS of patients diagnosed with cervical cancer was constructed and validated. The model was implemented in a nomogram and provides accurate prediction of individual patients' prognosis useful for patient counselling and deciding on follow-up strategies.
    British Journal of Cancer 08/2012; 107(6):918-24. DOI:10.1038/bjc.2012.340 · 4.84 Impact Factor
Show more


13 Reads
Available from