High-risk Factors And Prediction Model Of Lymph Node Metastasis In Endometrial Cancer

Objective:By studying the relationship between clinicopathological factors and lymph node metastasis of endometrial,exploring the risk factors of lymph node metastasis of endometrial cancer,a risk nomogram model for predicting lymph node metastasis was established.Method:268 cases of endometrial cancer were collected,all of whom were underwent a full staging operation for endometrial cancer during January,2015 to August,2020 in the first hospital of Lanzhou,University.The clinicopathological data were statistically analyzed.The,independent risk factors affecting endometrial cancer lymph node metastasis were screened out by univariate and multivariate analysis.And then,a risk nomogram model was established by R software,and its differential validity and accuracy were verified.Furthermore,the ROC curve of the total score of the nomogram model was made,and the endometrial cancer patients were divided into low-risk groups and high-risk groups according to the boundary value corresponding to the maximum value of the Youden index.Result:Univariate analysis of endometrial cancer lymph node metastasis showed that CA125>35U/ml(χ~2=12.817,P<0.001),non-endometrioid adenocarcinoma(χ~2=13.792,P<0.001),poor differentiation(χ~2=22.348,P<0.001),depth of myometrial invasion≥1/2(χ~2=12.817,P<0.001),tumor diameter>20mm(χ~2=3.877,P=0.049),adnexa involvement(P<0.001)and cervical interstitial invasion(χ~2=10.641,P<0.001)are the risk factors for lymph node metastasis of endometrial cancer.In multivariate analysis,and the results showed that CA125>35U/ml(OR=3.288,P=0.029),non-endometrioid adenocarcinoma(OR=4.795,P=0.022),depth of myometrial invasion≥1/2(OR=4.588,P=0.011)and poor differentiation(OR=3.617,P=0.022)are independent risk factors for lymph node metastasis of endometrial cancer.A nomogram model for predicting the risk of endometrial cancer lymph node metastasis was established.The internal verification of Bootstrap shows that the C-index is 0.88.The calibration curve was used for calibration to predict the probability and the truth.The absolute error of the probability is 0.022.Based on the nomogram model,if the total score<130,the patients were classified as low risk group,and if the total score≥130,classified as high-risk group.There were 75patients in the low-risk group and 68 patients in the high-risk group.The difference of the lymph node metastasis rate between the two groups was significant in statistical analysis(χ~2=6.097,P=0.014).Conclusion:The risk nomogram model,which is established by combining CA125,pathological type,histological grade,and depth of myometrial invasion,can be used to predict the risk of endometrial cancer lymph node metastasis.The risk stratification of patients allows clinicians to identify low-risk and high-risk early and formulate more precise and individualized treatment plans for patients.