Nomogram Based on Immune-Inflammatory Score and Classical Clinicopathological Parameters for Predicting the Recurrence of Endometrial Carcinoma: A Large, Multi-Center Retrospective Study

Overview

Journal J Inflamm Res

Publisher Dove Medical Press

Date 2024 Dec 30

PMID 39735898

Authors

Yuqi Wang

Yunfeng Zheng

Chenfan Tian

Jiaxin Yu

Kunying Rao

Na Zeng

Peng Jiang

Affiliations

Soon will be listed here.

Abstract

Background: Surgery is the best approach to treat endometrial cancer (EC); however, there is currently a deficiency in effective scoring systems for predicting EC recurrence post-surgical resection. This study aims to develop a clinicopathological-inflammatory parameters-based nomogram to accurately predict the postoperative recurrence-free survival (RFS) rate of EC patients.

Methods: A training set containing 1068 patients and an independent validation set consisting of 537 patients were employed in this retrospective study. The prognostic factors for RFS were identified by univariable and multivariable Cox proportional hazards regression analyses, and integrated into nomogram. The C-index, area under the curves (AUC), and calibration curves were employed to determine the predictive discriminability and accuracy of nomogram. Utilizing the nomogram, patients were stratified into low- and high-risk groups, and the Kaplan-Meier survival curve was further employed to assess the clinical efficacy of the model.

Results: Cox regression analyses revealed that age (HR = 1.769, = 0.002), FIGO staging (HR = 1.790, = 0.018), LVSI (HR = 1.654, = 0.017), Ca125 (HR = 1.532, = 0.023), myometrial invasion (HR = 1.865, = 0.001), cervical stromal invasion (HR = 1.655, = 0.033), histology (HR = 2.637, < 0.001), p53 expression (HR = 1.706, = 0.002), PLR (HR = 1.971, = 0.003), SIRI (HR = 2.187, P = 0.003), and adjuvant treatment (HR = 0.521, = 0.003) were independent prognostic factors for RFS in patients with EC. A combined clinicopathologic-inflammatory parameters model was constructed, which outperformed the single-indicator model and other established models in predicting the 1-, 3-, and 5-year RFS rates in patients with EC.

Conclusion: The nomogram demonstrated sufficient accuracy in predicting the RFS probabilities of EC, enabling personalized clinical decision-making for future clinical endeavors.

References

Schisterman E, Perkins N, Liu A, Bondell H . Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology. 2004; 16(1):73-81. DOI: 10.1097/01.ede.0000147512.81966.ba. View

Halla K . Emerging Treatment Options for Advanced or Recurrent Endometrial Cancer. J Adv Pract Oncol. 2022; 13(1):45-59. PMC: 8805805. DOI: 10.6004/jadpro.2022.13.1.4. View

Yang F, Zheng Y, Luo Q, Zhang S, Yang S, Chen X . Knockdown of NCAPD3 inhibits the tumorigenesis of non-small cell lung cancer by regulation of the PI3K/Akt pathway. BMC Cancer. 2024; 24(1):408. PMC: 10986035. DOI: 10.1186/s12885-024-12131-x. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Versluis M, de Jong R, Plat A, Bosse T, Smit V, MacKay H . Prediction model for regional or distant recurrence in endometrial cancer based on classical pathological and immunological parameters. Br J Cancer. 2015; 113(5):786-93. PMC: 4559831. DOI: 10.1038/bjc.2015.268. View

Mantovani A, Allavena P, Sica A, Balkwill F . Cancer-related inflammation. Nature. 2008; 454(7203):436-44. DOI: 10.1038/nature07205. View

Zheng Y, Shen Q, Yang F, Wang J, Zhou Q, Hu R . A nomogram model to predict recurrence of early-onset endometrial cancer after resection based on clinical parameters and immunohistochemical markers: a multi-institutional study. Front Oncol. 2024; 14:1442489. PMC: 11586258. DOI: 10.3389/fonc.2024.1442489. View

Raffone A, Travaglino A, Mascolo M, Carbone L, Guida M, Insabato L . TCGA molecular groups of endometrial cancer: Pooled data about prognosis. Gynecol Oncol. 2019; 155(2):374-383. DOI: 10.1016/j.ygyno.2019.08.019. View

Gordhandas S, Zammarrelli W, Rios-Doria E, Green A, Makker V . Current Evidence-Based Systemic Therapy for Advanced and Recurrent Endometrial Cancer. J Natl Compr Canc Netw. 2023; 21(2):217-226. PMC: 10361357. DOI: 10.6004/jnccn.2022.7254. View

10.

Cuccu I, Raspagliesi F, Malzoni M, Vizza E, Papadia A, Di Donato V . Sentinel node mapping in high-intermediate and high-risk endometrial cancer: Analysis of 5-year oncologic outcomes. Eur J Surg Oncol. 2024; 50(4):108018. DOI: 10.1016/j.ejso.2024.108018. View

11.

Jiang P, Wang J, Gong C, Yi Q, Zhu M, Hu Z . A Nomogram Model for Predicting Recurrence of Stage I-III Endometrial Cancer Based on Inflammation-Immunity-Nutrition Score (IINS) and Traditional Classical Predictors. J Inflamm Res. 2022; 15:3021-3037. PMC: 9135581. DOI: 10.2147/JIR.S362166. View

12.

Cong R, Kong F, Ma J, Li Q, Wu Q, Ma X . Combination of preoperative neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-lymphocyte ratio: a superior prognostic factor of endometrial cancer. BMC Cancer. 2020; 20(1):464. PMC: 7245911. DOI: 10.1186/s12885-020-06953-8. View

13.

Ouldamer L, Bendifallah S, Body G, Touboul C, Graesslin O, Raimond E . Predicting poor prognosis recurrence in women with endometrial cancer: a nomogram developed by the FRANCOGYN study group. Br J Cancer. 2016; 115(11):1296-1303. PMC: 5129824. DOI: 10.1038/bjc.2016.337. View

14.

Santoro A, Angelico G, Travaglino A, Raffone A, Arciuolo D, DAlessandris N . Clinico-pathological significance of TCGA classification and SWI/SNF proteins expression in undifferentiated/dedifferentiated endometrial carcinoma: A possible prognostic risk stratification. Gynecol Oncol. 2021; 161(2):629-635. DOI: 10.1016/j.ygyno.2021.02.029. View

15.

Deighton K . Cancer--a systemic disease with local manifestations. Med Hypotheses. 1975; 1(2):37-41. DOI: 10.1016/s0306-9877(75)80013-2. View

16.

Bogani G, Giannini A, Vizza E, Di Donato V, Raspagliesi F . Sentinel node mapping in endometrial cancer. J Gynecol Oncol. 2023; 35(1):e29. PMC: 10792208. DOI: 10.3802/jgo.2024.35.e29. View

17.

Wang J, Jiang P, Huang Y, Tu Y, Zhou Q, Li N . Prognostic Value of the Cutoffs for HALP in Endometrial Cancer. Am J Clin Oncol. 2023; 46(3):107-113. PMC: 9946170. DOI: 10.1097/COC.0000000000000977. View

18.

Schlesinger M . Role of platelets and platelet receptors in cancer metastasis. J Hematol Oncol. 2018; 11(1):125. PMC: 6180572. DOI: 10.1186/s13045-018-0669-2. View

19.

Zheng Y, Jiang P, Tu Y, Huang Y, Wang J, Gou S . Incidence, risk factors, and a prognostic nomogram for distant metastasis in endometrial cancer: A SEER-based study. Int J Gynaecol Obstet. 2023; 165(2):655-665. DOI: 10.1002/ijgo.15264. View

20.

Habanjar O, Bingula R, Decombat C, Diab-Assaf M, Caldefie-Chezet F, Delort L . Crosstalk of Inflammatory Cytokines within the Breast Tumor Microenvironment. Int J Mol Sci. 2023; 24(4). PMC: 9964711. DOI: 10.3390/ijms24044002. View