New online dynamic nomograms: recurrence-free and overall survival after resection of endometrial cancer

Abstract Background This study aimed to propose nomograms based on clinicopathological variables to predict recurrence-free survival (RFS) and overall survival (OS) in patients after surgical resection therapy for endometrial cancer (EC).Methods Patients who underwent surgical therapy for EC were identified in this single-institution retrospective cohort study from January 1, 2012, to August 31, 2022. Web-based nomograms were developed to predict RFS and OS following EC resection. C-statistics, calibration plots, and Kaplan-Meier curves were used to assess the discriminative and calibration abilities of the nomograms.Results This study included 289 patients who underwent surgery for EC. At a median follow-up of 51.1 (range, 4.1-128.3) months, 13.5% (39 of 289) of the patients showed a relapse or died from their disease. The median age of the participants was 56 years. Approximately one-tenth of the patients (10.7% [31/289]) had non-endometrioid tumor with a median size of 2.8 cm. RFS was predicted using the Akaike data criteria and a backward stepwise selection of clinically relevant variables: positive peritoneal cytology (PC; hazard ratio [HR], 35.58; 95% confidence interval [CI], 3.43-369.39; P = 0.0028), age-adjusted Charlson comorbidity index (AACCI) (HR, 25.51; 95% CI, 8.74–74.49; P < 0.001), FIGO stage III (HR, 3.01; 95% CI, 1.25–7.22; P = 0.0136), FIGO stage IV (HR, 82.92; 95% CI, 22.27-308.76; P < 0.001). Similarly, OS was predicted using depth of myometrial invasion ≥ 1/2 (HR, 1.18; 95% CI, 0.57–2.46; P = 0.6551), AACCI (HR, 20.09; 95% CI, 6.82–59.16; P < 0.001), FIGO stage III (HR, 3.23; 95% CI, 1.35–7.72; P = 0.0083), FIGO stage IV (HR, 81.56; 95% CI, 20.49-324.57; P < 0.001). Using C-statistics, the nomograms showed good predictive capability and positive discriminative ability and calibration (RFS: 0.895 and OS: 0.891).Conclusions Independent factors were chosen to predict survival and recurrence risk following surgical therapy for EC. The nomograms performed well in the internal validation when patients were stratified into prognostic groups.