Objective High grade endometrial stromal sarcoma is a rare and highly malignant tumor that lacks a prognostic model. The aim of this study was to develop a prognostic nomogram predicting the overall survival of patients with high grade endometrial stromal sarcoma.
Methods Clinical data for patients were derived from the Surveillance Epidemiology, and End Results database. Cox analysis and Akaike’s information criterion were used to construct the nomogram. The concordance index, time dependent receiver operating characteristic curve, and calibration plot were used to evaluate the discriminative and calibrating capability. The net reclassification index, integrated discrimination improvement, and concordance index change were also compared between the nomogram and the International Federation of Gynecology and Obstetrics (FIGO) stage. Clinical benefit was evaluated using decision curve analysis. The patients were separated into groups with low and high nomogram risk scores. Kaplan–Meier curve analysis and Cox analysis were used to investigate the survival difference between the two groups.
Results The training and validation cohorts had 461 and 195 patients, respectively. A nomogram that incorporated disease stage, age, surgery, lymph node status, radiotherapy, and chemotherapy for predicting overall survival was established and validated. The concordance index of the nomogram was 0.734 (0.708–0.761) in the training cohort and 0.705 (0.659–0.751) in the validation cohort. The calibration plots showed a favorable calibrating ability of the nomogram. The 1 year and 3 year time dependent receiver operating characteristic curves showed the better discriminative ability of the nomogram than the staging system. The concordance index change, net reclassification index, and integrated discrimination improvement also indicated a significantly (p<0.05) better predictive power of the nomogram over disease stage. Furthermore, decision curve analysis suggested that the nomogram was clinically useful and had a larger clinical net benefit than disease stage alone. Patients with a high risk score had distinctly poorer survival than those with low risk scores.
Conclusions A prognostic nomogram in patients with high grade endometrial stromal sarcoma exhibited favorable prognostic discrimination and survival prediction ability compared with FIGO stage.
- uterine cancer
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JW and HZ contributed equally.
Contributors Study design: JW, HZ, BX, and QS. Data collection: LL, MH, SW, and LC. Manuscript preparation: JW, LL, MH, and LC. Data analysis and interpretation: JW, SW, and HZ. All authors confirm they contributed to manuscript reviews—revising it critically for important intellectual content—and read and approved the final draft for submission. All authors are responsible for the manuscript content.
Funding The study was supported by grants Nos 81 670 123 and 81 670 144 from the National Natural Science Foundation of China (NSFC) and grant No. TFZZ2018025 from Wuhan University Medical Faculty Innovation Seed Fund Cultivation Project.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The clinical data in our study were derived from the Surveillance Epidemiology, and End Results (SEER) database, a public population based cancer database that was supported and managed by the National Cancer Institute, and the approval of all participants in this database was collected and managed by the SEER office.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository. The data of this study are available in the Surveillance Epidemiology, and End Results (SEER) database (https://seer.cancer.gov/).