Nomogram for the prediction of disease-free survival in FIGO 2023 stage IA2 endometrial cancer patients

The purpose of the research is to assess the risk factors that contribute to the recurrence of International Federation of Gynecology and Obstetrics (FIGO) 2023 stage IA2 endometrial cancer (EC) patients. The study was conducted by examining stage IA2 patients who underwent surgery for EC in the gynecological oncology clinic between 2008–2022. Study data were collected by retrospective evaluation. A total of 185 patients, 37 with recurrence and 148 in the control group, were included in the study. In the study, the recurrence rate among all stage IA2 EC was found to be 3.9%. The mean age was similar between the groups. Grade 2 tumors were found in 73.0% of patients in the case group and 34.5% in the control group. Tumor size was larger in the case group. Neutrophil lymphocyte ratio (NLR) value was significantly higher in the case group. Adjuvant radiotherapy was given to 42.6% of patients in the control group and 59.5% in the case group. The nomogram’s score was assessed for disease-free survival (DFS) using Concordance Correlation Coefficient analysis. The Concordance index (C-index) for the nomogram was 0.903. When 5-year DFS times were analyzed according to total nomogram score, a significant difference was found. Grade 2 tumor classification, negative estrogen receptor status, elevated cancer antigen 125 (CA125) levels (>35), large tumor size (≥3.0 cm) and high NLR (≥1.9) are identified as significant risk factors for recurrence in early-stage (IA2) and low-Grade EC patients. The total score derived from the nomogram constructed with these risk factors shows a notable variation in DFS.

Endometrial cancer; Disease-free survival; Recurrence; Neutrophil lymphocyte ratio

[1] Alhadeethi A, Ibrahim AA, Atia A, Alabdallat YJ, Alkhawaldeh IM, El Din Moawad MH. Clinical characteristics and prognostic factors of endometrial cancer patients with liver metastasis: a surveillance, epidemiology, and end results database (SEER)-based study of 1,034 women. Cureus. 2024; 16: e54606.

[2] Zheng Y, Jiang P, Tu Y, Huang Y, Wang J, Gou S, et al. Incidence, risk factors, and a prognostic nomogram for distant metastasis in endometrial cancer: a SEER-based study. International Journal of Gynaecology and Obstetrics. 2024; 165: 655–665.

[3] Xue Q, Che W, Xue L, Zhang X, Wang X, Lyu J. Causes of death in endometrial cancer survivors: a surveillance, epidemiology, and end result-based analysis. Cancer Medicine. 2023; 12: 10917–10930.

[4] Berek JS, Matias-Guiu X, Creutzberg C, Fotopoulou C, Gaffney D, Kehoe S, et al.; Endometrial Cancer Staging Subcommittee, FIGO Women’s Cancer Committee. FIGO staging of endometrial cancer: 2023. International Journal of Gynaecology and Obstetrics. 2023; 162: 383–394.

[5] Markowska A, Baranowski W, Pityński K, Chudecka-Głaz A, Markowska J, Sawicki W. Metastases and recurrence risk factors in endometrial cancer-the role of selected molecular changes, hormonal factors, diagnostic methods and surgery procedures. Cancers. 2023; 16: 179.

[6] Kaewpangchan P, Cheewakriangkrai C. Relapse patterns and outcomes following recurrence of endometrial cancer in Northern Thai women. Asian Pacific Journal of Cancer Prevention. 2015; 16: 3861–3866.

[7] Jeppesen MM, Jensen PT, Gilså Hansen D, Iachina M, Mogensen O. The nature of early-stage endometrial cancer recurrence—a national cohort study. European Journal of Cancer. 2016; 69: 51–60.

[8] Cancer Genome Atlas Research Network; Kandoth C, Schultz N, Cherniack AD, Akbani R, Liu Y, Shen H, et al. Integrated genomic characterization of endometrial carcinoma. Nature. 2013; 497: 67–73.

[9] Fung-Kee-Fung M, Dodge J, Elit L, Lukka H, Chambers A, Oliver T; Cancer Care Ontario Program in Evidence-based Care Gynecology Cancer Disease Site Group. Follow-up after primary therapy for endometrial cancer: a systematic review. Gynecologic Oncology. 2006; 101: 520–529.

[10] Francis SR, Ager BJ, Do OA, Huang YJ, Soisson AP, Dodson MK, et al. Recurrent early stage endometrial cancer: patterns of recurrence and results of salvage therapy. Gynecologic Oncology. 2019; 154: 38–44.

[11] Rios-Doria E, Cun HT, Filippova OT, Mueller JJ, Alektiar KM, Ellenson LH, et al. Isolated vaginal recurrence in women with stage I endometrial cancer. Gynecologic Oncology. 2023; 179: 9–15.

[12] Parsons MW, Huang YJ, Burt L, Suneja G, Gaffney D. Vaginal cuff brachytherapy for endometrial cancer: a review of major clinical trials with a focus on fractionation. International Journal of Gynecological Cancer. 2022; 32: 311–315.

[13] Laban M, El-Swaify ST, Ali SH, Refaat MA, Sabbour M, Farrag N, et al. The prediction of recurrence in low-risk endometrial cancer: is it time for a paradigm shift in adjuvant therapy? Reproductive Sciences. 2022; 29: 1068–1085.

[14] Krusun S, Pesee M, Rasio W, Tangvoraphonkchai V, Supaadirek C, Thamronganantasakul K, et al. Survival rate of early stage endometrioid adenocarcinoma of endometrium treated at Srinagarind Hospital. Asian Pacific Journal of Cancer Prevention. 2014; 15: 2217–2220.

[15] Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC, et al; PORTEC Study Group. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecologic Oncology. 2003; 89: 201–209.

[16] Kim SR, Pina A, Albert A, McAlpine JN, Wolber R, Gilks B, et al. Mismatch repair deficiency and prognostic significance in patients with low-risk endometrioid endometrial cancers. International Journal of Gynecological Cancer. 2020; 30: 783–788.

[17] Güngördük K, Firat Cüylan Z, Kahramanoglu I, Oge T, Akbayir O, Dede M, et al. Risk factors for recurrence in low-risk endometrial cancer: a case-control study. Oncology Research and Treatment. 2018; 41: 466–470.

[18] Nahshon C, Kadan Y, Lavie O, Ostrovsky L, Segev Y. Sentinel lymph node sampling versus full lymphadenectomy in endometrial cancer: a SEER database analysis. International Journal of Gynecological Cancer. 2023; 33: 1557–1563.

[19] Bogani G, Giannini A, Vizza E, Di Donato V, Raspagliesi F. Sentinel node mapping in endometrial cancer. Journal of Gynecologic Oncology. 2024; 35: e29.