Elsevier

Gynecologic Oncology

Volume 125, Issue 3, June 2012, Pages 526-530
Gynecologic Oncology

External validation of a nomogram predicting overall survival of patients diagnosed with endometrial cancer

https://doi.org/10.1016/j.ygyno.2012.03.030Get rights and content

Abstract

Objectives

Nomograms are predictive models that provide the overall probability of a specific outcome. Nomograms have shown better individual discrimination than currently used staging systems in numerous tumor entities. Recently, a nomogram for predicting overall survival (OS) in women with endometrial cancer was introduced by Memorial Sloan–Kettering Cancer Center (MSKCC). The aim of this study was to test the validity of the MSKCC endometrial cancer nomogram using an independent, external patient cohort.

Methods

The MSKCC nomogram is based on five readily available clinical characteristics. A multi-institutional endometrial cancer database was used to test the nomogram's validity. All consecutive patients treated for endometrial cancer between December 1995 and May 2011 and who had all nomogram variables documented were identified for analysis.

Results

Seven hundred sixty-five eligible patients were identified and used for external validation analysis. In the Austrian patient cohort, median OS was 134 months, and 3-year and 5-year OS rates were 83.8% (95% CI, 80.6–86.5%) and 77.2% (95% CI, 43.5–80.5%), respectively. The nomogram concordance index was 0.71 (SE = 0.017; 95% CI, 0.68–0.74). The correspondence between the actual OS and the nomogram predictions suggests a good calibration of the nomogram in the validation cohort.

Conclusion

The MSKCC endometrial cancer nomogram was externally validated and was shown to be generalizable to a new and independent patient population. The nomogram provides a more individualized and accurate estimation of OS for patients diagnosed with endometrial cancer following primary therapy. The nomogram can be used for counseling patients more accurately and for better stratifying patients for clinical trials.

Highlights

► The Memorial Sloan–Kettering Cancer Center endometrial cancer nomogram was externally validated. ► The use of this nomogram allows for more individual patient counseling.

Introduction

Nomograms are predictive models that provide the overall probability of a specific outcome [1]. Several recently constructed nomograms have shown better individual discrimination than current staging systems [2], [3], [4], [5], [6]. Endometrial cancer is the most common gynecologic malignancy in the United States [7]. Patient counseling and treatment planning is primarily based on the International Federation of Gynecology and Obstetrics (FIGO) system. The staging system was recently revised for endometrial cancer by modifying the 1988 staging criteria; these changes have been controversial [8], [9]. Clinicopathological factors, other than those listed by the FIGO system, may play equally important roles in defining distinctive outcome groups [10], [11], [12].

Memorial Sloan–Kettering Cancer Center (MSKCC) recently constructed a nomogram to predict overall survival (OS) in women with endometrial cancer following primary therapy [2]. The nomogram was constructed based on clinicopathologic findings, such as age, stage, grade, histology, and number of negative lymph nodes, which were found to be clinically significant. The model was constructed using a large, single-institution (MSKCC) cohort of patients diagnosed with endometrial cancer. The model was internally validated using cross-validation and bootstrapping methods. Nevertheless, external validation in an independent set of patients is crucial to ensure external applicability to patients from different institutions. The aim of this study was to investigate whether the recently introduced nomogram is generalizable to a new population of patients with endometrial cancer. A database of two large European academic cancer centers was used for external validation.

Section snippets

Patients

The institutional review boards of MSKCC, the Medical University of Vienna, and the Medical University of Innsbruck approved this study. Data were abstracted from the institutions' prospectively maintained endometrial cancer databases following the same inclusion criteria [2]. Electronic medical records and surgery notes were also reviewed. In total, 874 patients with endometrial cancer received primary surgical treatment at the Medical University of Vienna (Vienna, Austria) and the Medical

Patients

Seven hundred sixty-five eligible patients were included in this study—419 from the Comprehensive Cancer Center Vienna and 346 from the Medical University of Innsbruck. Patient characteristics of the MSKCC cohort and the new validation cohort (the Austrian cohort) are provided in Table 1. Both cohorts were mainly composed of Caucasian women. One of the main differences between the two cohorts was a significantly higher rate of patients with papillary and serous histologies in the MSKCC cohort.

Discussion

MSKCC recently published a nomogram for predicting OS in women diagnosed with endometrial cancer [2]. The MSKCC endometrial cancer nomogram is based on five readily available clinical patient characteristics and pathologic information, including age at diagnosis, number of negative lymph nodes, stage according to the 1988 FIGO classification, and histologic grade and subtype (Fig. 2). Current staging systems do not incorporate these factors [8], [9]. As previously discussed, this nomogram was

Conflict of interest statement

Stephan Polterauer, Qin Zhou, Christoph Grimm, Veronika Seebacher, Alexander Reinthaller, Gerda Hofstetter, Nicole Concin, Richard R. Barakat, Nadeem R. Abu-Rustum, and Alexia Iasonos declare no conflict of interest. Mario M. Leitao, Jr is a proctor for Intuitive Surgical and is on the Speaker's Bureau and has done consulting for Vermillion.

References (16)

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