预测子宫内膜癌淋巴结转移风险的列线图构建研究

A nomogram to predict lymph node metastasis of endometrial cancer

目的探讨子宫内膜癌临床病理特征与淋巴结转移的关系,同时建立列线图模型预测行简单子宫切除且术后病理偶然诊断为子宫内膜癌患者淋巴结转移情况。方法回顾性收集2009年9月至2018年3月于福建医科大学第一附属医院274例行子宫切除及淋巴结清扫术的子宫内膜癌患者术后临床病理资料,运用logistic回归分析确定子宫内膜癌淋巴结转移的高危因素。建立预测子宫内膜癌淋巴结转移风险的列线图模型,分别用一致性系数(Cindex)和校准曲线评估模型的预测性能和符合度。结果 274例子宫内膜癌患者中,共有25例出现淋巴结转移,阳性率9.1%。多因素分析结果显示术前CA125>35 kU/L、肌层浸润程度≥1/2和淋巴血管间隙浸润是子宫内膜癌淋巴结转移的高危因素,其OR值分别2.971(95%CI 1.131～7.804)、4.795(95%CI 1.497～15.361)、4.773(95%CI 1.675～13.599)。用于预测淋巴结转移风险的列线图有良好的一致性系数(C-index=0.835)和良好的校准。结论基于术前CA125>35 kU/L、肌层浸润程度≥1/2和淋巴血管间隙浸润构建的列线图可用于指导因良性病因或子宫内膜不典型增生行简单子宫切除且术后病理偶然诊断为子宫内膜癌患者的进一步治疗。

Objective To explore the relationship between clinicopathological features and lymph node metastasis of endometrial cancer,and establish a nomogram model to predict lymph node metastasis in patients undergoing hysterectomy who were accidentally diagnosed with endometrial cancer.Methods Retrospectively collect clinical pathological data of274 patients with endometrial carcinoma undergoing hysterectomy and lymphadenectomy at the First Affiliated Hospital of Fujian Medical University from September 2009 to March 2018.Logistic regression analysis was used to determine the risk factors for lymph node metastasis of endometrial cancer.A nomogram model for predicting the risk of lymph node metastasis was established,and the predictive performance and compliance of the model were evaluated using the consistency index（C-index）and the calibration curve.Results Among 274 patients with endometrial cancer,25 had lymph node metastasis,with a positive rate of 9.1%.Multivariate analysis showed that preoperative CA125 levels35 kU/L,myometrial invasion≥1/2 and lymphangitic space infiltration were high risk factors for lymph node metastasis in endometrial carcinomas.Their OR values were 2.971（95% CI 1.131～7.804）,4.795（95% CI 1.497～15.361）and 4.773（95% CI 1.675～13.599）.The nomogram used to predict the risk of lymph node metastasis had a good agreement coefficient（C-index=0.835）and a good calibration.Conclusion A nomogram has been constructed based on preoperative CA125 levels35 kU/L,myometrial invasion≥1/2 and lymphovascular space invasion.The nomogram can be used to decide if further treatment is required for patients who have undergone simple hysterectomy for a benign etiology or endometrial dysplasia and are incidentally diagnosed with endometrial cancer by pathological evaluation.