| Objective:Endometrioid ovarian carcinoma(EOVC)is a special histological subtype of epithelial ovarian cancer(EOC).This study was expected to analyze the clinical characteristics and prognosis in patients with primary EOVC from SEER(Surveillance,Epidemiology,and End Results)database and two clinical centers in China,assess the risk factors related with unfavorable prognosis,and construct a nomogram model to predict prognosis.The purpose of this study is to provide more supporting evidence for the diagnosis,clinical management of EOVC,better guiding the follow-up treatment,and improving the outcome of EOVC patients.Methods:In this study,884 patients with primary EOVC were collected from the SEER database to analyze their clinical characteristics and prognostic data.Meanwhile,a nomogram model was constructed to predict survival probability according to the results of Cox regression analysis.Besides that,we collected the clinical information and follow-up outcome of 87 patients with primary EOVC between 2010 to 2020 treated at the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)and Sun Yat-sen Memorial Hospital,Sun Yat-sen University for clinical characteristics and prognostic analysis as well as comparison with the data of EOVC patients in the SEER database.Results:Our study showed that the average onset age of 884 patients with primary EOVC from SEER database was 55.77±12.40 years old,of whom FIGO(International Federation of Gynecology and Obstetrics)I-IIIB stage and FIGO IIIC-IV stage accounted for 90.7%and 8.1%respectively.Besides,5.7%of patients have lymph node metastasis and 61%of patients with abnormal CA125(Carbohydrate antigen 125)levels.In prognosis analysis,we found that elderly patients,advanced stage,worse grade of differentiation,incomplete cytoreduction,lymph node metastasis,and abnormal CA125 increase were independent risk factors associating with overall survival(OS)and cancer-specific survival(CSS)of patients with EOVC.In our two centers,the average onset age of 87patients with primary EOVC was 47.14±11.50 years old,and patients at early and advanced stage accounted for 74.7%and 25.3%respectively.Meanwhile,27.6%of patients were diagnosed with synchronous endometriosis.The abnormal proportions of CA125,HE4(Humanepididymisprotein4)and CA19-9(Carbohydrate antigen 19-9)were 83.9%,64.37%and 48.28%respectively.Estrogen receptor(ER)positive,progesterone receptor(PR)positive,β-catenin positive,Napsin A negative and WT-1(Wilms Tumor 1)negative of tumor tissues detected by immunohistochemistry accounted for 87.3%,72.7%,100.0%,82.6%and 65.1%respectively.In Kaplan-Meier survival curve,advanced stage,HE4 level(>179 pmol/L)and bilateral ovarian involved significantly correlated with decreased OS and progression-free survival(PFS).Body mass index(BMI)(<19.34kg/m~2)was independent risk factor relating to OS and PFS.The laterality of ovarian involved and stage were also independent risk factors of OS.In addition,the nomogram model for predicting the prognosis of patients with EOVC in SEER database was established from age,pathological differentiation status,stage,complete cytoreduction,lymph node metastasis and CA125 level,and the concordance index(C-index)was 0.812(OS)and 0.863(CSS)for internal verification using Bootstrap self-sampling,0.754(OS)and 0.676(CSS)for external data verification.Conclusion:(1)Most primary EOVC patients were diagnosed at an early stage,the average age of onset was younger in Asian/Pacific Islander and some Chinese,accompanied by CA125and HE4 elevation.Meanwhile,approximately a quarter of patients with EOVC were often diagnosed with endometriosis.(2)Positive expression of ER,PR andβ-catenin and negative expression of WT-1 and Napsin A of tumor tissue might be suitable as special molecular markers for the diagnosis of most EOVC patients.(3)In the analysis of data in SEER database and our two centers,the elder,worse grade of differentiation,advanced stage,and BMI<19.34kg/m~2 may be independent risk factors for prognosis.In addition,lymph node metastasis according to SEER data analysis and HE4>179pmol/L according to our two centers assay were both valuable for prognostic evaluation. |
