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Open Access 01-12-2021 | Research

Nomogram to predict overall survival based on the log odds of positive lymph nodes for patients with endometrial carcinosarcoma after surgery

Authors: Linzhi Gao, Jun Lyu, Xiaoya Luo, Dong Zhang, Guifang Jiang, Xian Zhang, Xuesong Gao, Shaolie Zheng, Xiaoyu Wang, Yuan Shen

Published in: BMC Cancer | Issue 1/2021

Abstract

Purpose

Aims to compare the prognostic performance of the number of positive lymph nodes (PLNN), lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) and establish a prognostic nomogram to predict overall survival (OS) rate for patients with endometrial carcinosarcoma (ECS).

Methods

Patients were retrospectively obtained from Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2015. The prognostic value of PLNN, LNR and LODDS were assessed. A prediction model for OS was established based on univariate and multivariate analysis of clinical and demographic characteristics of ECS patients. The clinical practical usefulness of the prediction model was valued by decision curve analysis (DCA) through quantifying its net benefits.

Results

The OS prediction accuracy of LODDS for ECS is better than that of PLNN and LNR. Five factors, age, tumor size, 2009 FIGO, LODDS and peritoneal cytology, were independent prognostic factors of OS. The C-index of the nomogram was 0.743 in the training cohort. The AUCs were 0.740, 0.682 and 0.660 for predicting 1-, 3- and 5-year OS, respectively. The calibration plots and DCA showed good clinical applicability of the nomogram, which is better than 2009 FIGO staging system. These results were verified in the validation cohort. A risk classification system was built that could classify ECS patients into three risk groups. The Kaplan-Meier curves showed that OS in the different groups was accurately differentiated by the risk classification system and performed much better than FIGO 2009.

Conclusion

Our results indicated that LODDS was an independent prognostic indicator for ECS patients, with better predictive efficiency than PLNN and LNR. A novel prognostic nomogram for predicting the OS rate of ECS patients was established based on the population in the SEER database. Our nomogram based on LODDS has a more accurate and convenient value for predicting the OS of ECS patients than the FIGO staging system alone.

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Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30. https://doi.org/10.3322/caac.21590.CrossRef

Cantrell LA, Blank SV, Duska LR. Uterine carcinosarcoma: a review of the literature. Gynecol Oncol. 2015;137(3):581–8. https://doi.org/10.1016/j.ygyno.2015.03.041.CrossRefPubMed

Matsuzaki S, Klar M, Matsuzaki S, Roman LD, Sood AK, Matsuo K. Uterine carcinosarcoma: contemporary clinical summary, molecular updates, and future research opportunity. Gynecol Oncol. 2021;160(2):586–601. https://doi.org/10.1016/j.ygyno.2020.10.043.CrossRefPubMed

Sherman ME, Devesa SS. Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus. Cancer. 2003;98(1):176–86. https://doi.org/10.1002/cncr.11484.CrossRefPubMed

Vitale SG, Laganà AS, Capriglione S, Angioli R, La Rosa VL, Lopez S, et al. Target Therapies for Uterine Carcinosarcomas: Current Evidence and Future Perspectives. Int J Mol Sci. 2017;18(5). https://doi.org/10.3390/ijms18051100.

Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, et al. Prognostic factors and treatment outcomes of patients with uterine sarcoma: analysis of 127 patients at a single institution, 1989-2007. J Cancer Res Clin Oncol. 2008;134(12):1277–87. https://doi.org/10.1007/s00432-008-0422-2.CrossRefPubMed

Naaman Y, Shveiky D, Ben-Shachar I, Shushan A, Mejia-Gomez J, Benshushan A. Uterine sarcoma: prognostic factors and treatment evaluation. Isr Med Assoc J. 2011;13(2):76–9.PubMed

Riopel J, Plante M, Renaud MC, Roy M, Têtu B. Lymph node metastases in low-grade endometrial stromal sarcoma. Gynecol Oncol. 2005;96(2):402–6. https://doi.org/10.1016/j.ygyno.2004.10.021.CrossRefPubMed

Machida H, Nathenson MJ, Takiuchi T, Adams CL, Garcia-Sayre J, Matsuo K. Significance of lymph node metastasis on survival of women with uterine adenosarcoma. Gynecol Oncol. 2017;144(3):524–30. https://doi.org/10.1016/j.ygyno.2017.01.012.CrossRefPubMedPubMedCentral

10.

Yoon A, Park JY, Park JY, Lee YY, Kim TJ, Choi CH, et al. Prognostic factors and outcomes in endometrial stromal sarcoma with the 2009 FIGO staging system: a multicenter review of 114 cases. Gynecol Oncol. 2014;132(1):70–5. https://doi.org/10.1016/j.ygyno.2013.10.029.CrossRefPubMed

11.

Warschkow R, Guller U, Tarantino I, Cerny T, Schmied BM, Thuerlimann B, et al. Improved survival after primary tumor surgery in metastatic breast Cancer: a propensity-adjusted, Population-based SEER Trend Analysis. Ann Surg. 2016;263(6):1188–98. https://doi.org/10.1097/SLA.0000000000001302.CrossRefPubMed

12.

Spolverato G, Ejaz A, Kim Y, Squires MH, Poultsides G, Fields RC, et al. Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma. Ann Surg. 2015;262(6):991–8. https://doi.org/10.1097/SLA.0000000000001040.CrossRefPubMed

13.

Shao Y, Geng Y, Gu W, Ning Z, Huang J, Pei H, et al. Assessment of lymph node ratio to replace the pN categories system of classification of the TNM system in esophageal squamous cell carcinoma. J Thorac Oncol. 2016;11(10):1774–84. https://doi.org/10.1016/j.jtho.2016.06.019.CrossRefPubMed

14.

Zhou R, Zhang J, Sun H, Liao Y, Liao W. Comparison of three lymph node classifications for survival prediction in distant metastatic gastric cancer. Int J Surgery (London, England). 2016;35:165–71.CrossRef

15.

Deng W, Xu T, Wang Y, Xu Y, Yang P, Gomez D, et al. Log odds of positive lymph nodes may predict survival benefit in patients with node-positive non-small cell lung cancer. Lung Cancer. 2018;122:60–6. https://doi.org/10.1016/j.lungcan.2018.05.016.CrossRefPubMed

16.

Fader AN, Java J, Tenney M, Ricci S, Gunderson CC, Temkin SM, et al. Impact of histology and surgical approach on survival among women with early-stage, high-grade uterine cancer: an NRG oncology/gynecologic oncology group ancillary analysis. Gynecol Oncol. 2016;143(3):460–5. https://doi.org/10.1016/j.ygyno.2016.10.016.CrossRefPubMedPubMedCentral

17.

Desai NB, Kollmeier MA, Makker V, Levine DA, Abu-Rustum NR, Alektiar KM. Comparison of outcomes in early stage uterine carcinosarcoma and uterine serous carcinoma. Gynecol Oncol. 2014;135(1):49–53. https://doi.org/10.1016/j.ygyno.2014.07.097.CrossRefPubMed

18.

Kurnit KC, Previs RA, Soliman PT, Westin SN, Klopp AH, Fellman BM, et al. Prognostic factors impacting survival in early stage uterine carcinosarcoma. Gynecol Oncol. 2019;152(1):31–7. https://doi.org/10.1016/j.ygyno.2018.10.034.CrossRefPubMed

19.

Ferguson SE, Tornos C, Hummer A, Barakat RR, Soslow RA. Prognostic features of surgical stage I uterine carcinosarcoma. Am J Surg Pathol. 2007;31(11):1653–61. https://doi.org/10.1097/PAS.0b013e3181161ba3.CrossRefPubMed

20.

Thiel FC, Halmen S. Low-grade endometrial stromal sarcoma - a review. Oncol Res Treatment. 2018;41(11):687–92. https://doi.org/10.1159/000494225.CrossRef

21.

Rauh-Hain JA, del Carmen MG. Endometrial stromal sarcoma: a systematic review. Obstet Gynecol. 2013;122(3):676–83. https://doi.org/10.1097/AOG.0b013e3182a189ac.CrossRefPubMed

22.

Yu Y, Zhang P, Yao R, Wang J, Wang P, Xue X, et al. Prognostic value of log odds of positive lymph nodes in node-positive lung squamous cell carcinoma patients after surgery: a SEER population-based study. Transl Lung Cancer Res. 2020;9(4):1285–301. https://doi.org/10.21037/tlcr-20-193.CrossRefPubMedPubMedCentral

23.

Zhang XF, Xue F, Dong DH, Lopez-Aguiar AG, Poultsides G, Makris E, et al. New nodal staging for primary pancreatic neuroendocrine tumors: a multi-institutional and National Data Analysis. Ann Surg. 2019;274(1):e28–35. https://doi.org/10.1097/SLA.0000000000003478.CrossRef

24.

Wang J, Li J, Chen R, Lu X. Contribution of lymph node staging method and prognostic factors in malignant ovarian sex cord-stromal tumors: a world wide database analysis. Eur J Surg Oncol. 2018;44(7):1054–61. https://doi.org/10.1016/j.ejso.2018.03.027.CrossRefPubMed

25.

Huang L, Jansen L, Balavarca Y, van der Geest L, Lemmens V, Groot Koerkamp B, et al. Significance of examined lymph node number in accurate staging and long-term survival in resected stage I-II pancreatic Cancer-more is better? A Large International Population-based Cohort Study. Ann Surg. 2019. https://doi.org/10.1097/SLA.0000000000003558.

26.

Zhou YY, Du XJ, Zhang CH, Aparicio T, Zaanan A, Afchain P, et al. Comparison of three lymph node staging schemes for predicting the outcome in patients with small bowel adenocarcinoma: a population-based cohort and international multicentre cohort study. EBioMedicine. 2019;41:276–85. https://doi.org/10.1016/j.ebiom.2019.02.043.CrossRefPubMedPubMedCentral

27.

Guo Q, Zhu J, Wu Y, Wen H, Xia L, Yu M, et al. Comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery. J Cancer. 2020;11(24):7339–47. https://doi.org/10.7150/jca.48085.CrossRefPubMedPubMedCentral

28.

Creasman WT, Ali S, Mutch DG, Zaino RJ, Powell MA, Mannel RS, et al. Surgical-pathological findings in type 1 and 2 endometrial cancer: an NRG oncology/gynecologic oncology group study on GOG-210 protocol. Gynecol Oncol. 2017;145(3):519–25. https://doi.org/10.1016/j.ygyno.2017.03.017.CrossRefPubMedPubMedCentral

29.

Matsuo K, Takazawa Y, Ross MS, Elishaev E, Podzielinski I, Yunokawa M, et al. Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma. Ann Oncol. 2016;27(7):1257–66. https://doi.org/10.1093/annonc/mdw161.CrossRefPubMed

30.

Matsuo K, Nusbaum DJ, Matsuzaki S, Chang EJ, Roman LD, Wright JD, et al. Malignant peritoneal cytology and increased mortality risk in stage I non-endometrioid endometrial cancer. Gynecol Oncol. 2020;159(1):43–51. https://doi.org/10.1016/j.ygyno.2020.07.010.CrossRefPubMedPubMedCentral

31.

Fitzgerald M, Saville BR, Lewis RJ. Decision curve analysis. Jama. 2015;313(4):409–10. https://doi.org/10.1001/jama.2015.37.CrossRefPubMed

32.

Yang J, Li Y, Liu Q, Li L, Feng A, Wang T, et al. Brief introduction of medical database and data mining technology in big data era. J Evid Based Med. 2020;13(1):57–69. https://doi.org/10.1111/jebm.12373.CrossRefPubMedPubMedCentral

Title: Nomogram to predict overall survival based on the log odds of positive lymph nodes for patients with endometrial carcinosarcoma after surgery
Authors: Linzhi Gao
Jun Lyu
Xiaoya Luo
Dong Zhang
Guifang Jiang
Xian Zhang
Xuesong Gao
Shaolie Zheng
Xiaoyu Wang
Yuan Shen
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-08888-0

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