| Objective:Uterine sarcomas are rare,aggressive and have a poor prognosis.The purpose of this study is to explore the influencing factors of overall survival and cancer-specific survival in patients with uterine sarcoma,and to construct and validate a nomogram model for the prognosis of uterine sarcoma,which can be used to evaluate the prognosis of clinical patients.Methods:The data of 1416 patients with pathologically confirmed uterine sarcomas from2010 to 2015 were obtained from The Surveillance,Epidemiology and End Results cancer registry database.According to a ratio of 7:3,the training group(n=992)and validation groups group(n=424)were divided by all patients.The survival of patients in the training group was analyzed,to identify risk factors that influence overall survival rate and cancer-specific survival rate in patients with uterine sarcoma,and the above significant variables were included to construct a nomogram prediction model.Internal validation using validation group data,using the area under the ROC curve,consistency index and the accuracy of the prediction model for the evaluation of the calibration curve.Then,decision analysis curve was used to verify the clinical practicability of nomogram,and compared with the FIGO staging published by the International Federation of Obstetricians and Gynaecologists.Results:In this study included 1416 patients with uterine sarcoma,719(50.8%)patients died during the follow-up period,of which 656(46.3%)patients had died of uterine sarcomas.The results of multivariate analysis showed that: Age,race,histological grade,lymph node metastasis status,distant metastasis status,whether surgery and tumor size were independent influencing factors for OS(P<0.05).Meanwhile,age,histological grade,lymph node metastasis status,distant metastasis status,whether surgery and tumor size were also independent influencing factors for CSS(P<0.05).The above meaningful factors were integrated to build OS and CSS nomogram models.In the modeling group and the validation group,the concordance index values for predicting OS nomogram were 0.781(95%CI: 0.801-0.761)and 0.785(95%CI:0.814-0.756),respectively.Similarly,the concordance index of predicted CSS nomogram was 0.780(95%CI: 0.80-0.76)in the modeling group and 0.790(95%CI:0.815-0.76)in the validation group.The AUC values of the 1,3,and 5 year OS and CSS nomogram were all greater than 0.80 in the modeling group and the validation group.Concordance index and AUC results show that the nomogram has good discrimination ability,indicating that the nomogram prediction results are relatively accurate.The calibration curves show that the predicted values of OS and CSS nomogram are in good agreement with the actual observed values.Finally,the DCA curve showed that nomogram was significantly better than FIGO staging system,that is,nomogram had better predictive performance and was more suitable for clinical use.Conclusion:1.Age > 51 years old,black,poorly differentiated or undifferentiated histology,lymph node metastasis status,distant metastasis and tumor size > 60 mm were adverse factors for overall survival.Age > 51 years old,poorly differentiated or undifferentiated histology,lymph node metastasis status,distant metastasis,and tumor size > 60 mm were also adverse factors for cancer-specific survival of uterine sarcoma.Surgical treatment was a protective factor for overall survival and cancer-specific survival.2.The nomogram constructed in this study has good prediction performance,which can accurately evaluate the overall survival rate and cancer-specific survival rate of patients with uterine sarcoma,and has certain reference value for clinical patients,which is helpful for clinical patient management. |
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