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| High-risk factors of lymph node metastasis of endometrial cancer and the construction of prediction model#br# |
| CHEN Silu1,2 SONG Kairong1,2 LIU Yuan1,2 YANG Yongxiu1,2,3 |
1.The First Hospital of Lanzhou University, Gansu Province, Lanzhou 730000, China;
2.Gansu Pronincial Key Laboratory of Gynecological, Gansu Province, Lanzhou 730000, China;
3.Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Gansu Province, Lanzhou 730000, China |
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Abstract Objective To study the relationship between clinicopathological factors and endometrial cancer (EC) lymph node metastasis, to explore the risk factors of lymph node metastasis, and to construct its risk nomogram prediction model. Methods Retrospectively collected the clinical data of 268 patients who were diagnosed with EC and undergo a full staging operation from January 2015 to August 2020 in the First Hospital of Lanzhou University. According to the presence or absence of lymph node metastasis, they were divided into metastatic group and non-metastatic group. Among them, there were 247 cases in the metastatic group and 21 cases in the non-metastatic group. Single-factor and multi-factor logistic regression analysis were used to screen the risk factors of lymph node metastasis, and R software was used to construct a nomogram model for predicting the risk of lymph node metastasis, and to evaluate the prediction model. The total score of the nomogram model to draw the receiver operating characteristic curve was used, and the lymph node metastasis of different risk strata in patients with EC was analyzed. Results The proportion of carbohydrate antigen 125 (CA125), pathological type, histological grade, depth of myometrial invasion, cervical interstitial invasion, adnexal metastasis and tumor size were compared between the two groups, and the differences were statistically significant (P ＜ 0.05). Multivariate analysis showed that preoperative CA125＞35 U/ml (OR = 3.288), non-endometrioid adenocarcinoma (OR = 4.795), poorly differentiated (OR = 3.617), and depth of muscle invasion ≥ 1/2 (OR = 4.588) were independent risk factors for EC lymph node metastasis (P ＜ 0.05). The prediction model had been internally verified to obtain a consistency index of 0.88, and the calibration curve showed an average absolute error of 0.022. The total score of the nomogram model was less than 130 as low risk, and the total score was more than 130 as high risk. There was a statistically significant difference in lymph node metastasis in patients with different risk strata (P ＜ 0.05). Conclusion The risk nomogram model established by preoperative CA125 level, pathological type, histological grade, and depth of muscle invasion can be used to predict the risk of EC lymph node metastasis. At the same time, the risk stratification of patients allows clinicians to identify low-risk and high-risk patients early, guide clinicians to formulate more precise and individualized treatment plans, and at the same time guide follow-up adjuvant treatment for patients who are accidentally diagnosed with EC due to postoperative medical examinations.
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