The Initial Establishment And Evaluation Of Nomogram Model To Predict The Risk Of Lymphatic Metastasis Of Patients With Endometrial Cancer

Objective: To explore the the relationship between clinical pathological parameters and lymphatic metastasis in patients with endometrial cancer; Analysis of combined biomarkers in the prediction of lymphatic metastasis; Establish and evaluate a nomogram model for predicting the risk of lymphatic metastasis.Method: A retrospective analysis of patients with endometrial cancer admitted to Shanghai Jiao Tong University Affiliated Sixth People’s Hospital from January 1, 2008,to December 31, 2014 was performed by collecting 182 cases with qualified staging surgery. Detailed records including preoperative serum CA125, histological grade,myometrial invasion depth, lymphovascular invasion, lymphatic metastasis and other clinical pathologic parameters were carefully collected. The correlation between immunohistochemistry biomarkers ER, PR, p53, EGFR, c-erB-2, ki-67 and lymphatic metastases was studied independently. Through multivariate logistic regression analysis,ROC curve was drawn to evaluate combined biomarkers and clinical pathological parameters. A nomogram model to predict the risk of lymphatic metastasis was established and evaluated by internal verification and discrimination.Results: Among 182 patients with endometrial cancer, 156 cases had pelviclymphadenectomy, 26 cases had both pelvic lymphadenectomy and paro-arota lymphadenectomy. Postoperative pathological examination confirmed 14 cases(7.7%)with pelvic lymphatic metastasis, 4 cases(2.2%) with both pelvic and para-aortic lymphatic metastases. The area under the ROC curve of preoperative serum CA125 in predicting lymphatic metastasis was 0.804(95% CI: 0.697-0.901). When the threshold was 40U/mL, sensitivity and specificity of CA125 were 83.6% and 80.3% respectively.Univariate analysis showed that the rates of lymphatic metastasis in different pathological type, grade, lymphvascular invasion and myometrial invasion were significantly different(P < 0.05). The expression status of PR, p53, EGFR, c-er B-2 and ki-67 in patients were statistically different between positive and negative lymph nodes respectively(P < 0.05). Multiple logistic regression analysis demonstrated the expression of EGFR, c-erB-2 and ki-67 is independently risk factor for lymphatic metastasis with the regression coefficients 2.086, 1.853 and 1.337. The AUC of the combined biomarkers was 0.897(95%CI: 0.809-0.933), greater than the independent predictors. The nomogram predicting the risk showed a high concordance index(C-index: 0.743) by bootstrap resampling for internal validation.Conclusion: Based on the clinical and pathological findings of 182 patients with endometrial cancer, a nomogram to predict the probability of lymphatic metastasis has been successfully constructed with a high overall accuracy. The nomogram has certain clinical application prospect.