title: Nomograms to predict isolated loco-regional or distant recurrence among women with uterine cancer.
abstract: OBJECTIVE
  While there is ample literature on prognostic factors for uterine cancer, currently there are nomeans to estimate an individual's risk for recurrence or to differentiate the risk of loco-regional recurrence from distant recurrence. We addressed this gap by developing nomograms to individualize the risk of recurrence.
  
  
  METHODS
  A total of 2097 consecutive patients who underwent primary surgery between 1997 and 2007 were included. Sixteen covariates were evaluated for their prognostic significance and modeled using multivariable competing risks regression to predict three-year outcomes as part of a nomogram. Each covariate in the nomogram is assigned a value, and a sum of these values form the overall risk score from which three-year incidence probabilities can be predicted for each individual. Predictive accuracy was assessed with concordance index and then corrected for optimism.
  
  
  RESULTS
  The median follow-up time (inter-quartile range, IQR) was 50.0 (28.3-77.5) months and 221 patients developed a recurrence (127 patients with isolated loco-regional recurrence, 94 patients with distant recurrence). The nomograms included the following covariates: age at diagnosis, FIGO stage (2009), grade, lymphovascular invasion, histological type, depth of myometrial invasion, and peritoneal cytology. Concordance indices for isolated loco-regional and distant recurrences were 0.73 and 0.86, respectively.
  
  
  CONCLUSIONS
  Our nomograms quantify an individual patient's risk of isolated loco-regional and distant recurrence, using factors that are routinely collected. They may assist clinicians to assess an individual's prognosis, individualize treatment and also assist in the risk stratification in prospective randomized clinical trials evaluating the effectiveness of treatments for uterine cancer.
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Kondalsamy-Chennakesavan
authors.forename: Changhong
authors.initials: C
authors.lastname: Yu
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Yee
authors.initials: Y
authors.lastname: Leung
authors.forename: Peter
authors.initials: P
authors.lastname: Sykes
authors.forename: Marcelo
authors.initials: M
authors.lastname: Nascimento
authors.forename: James
authors.initials: J
authors.lastname: Nicklin
authors.forename: Lewis
authors.initials: L
authors.lastname: Perrin
authors.forename: Alex
authors.initials: A
authors.lastname: Crandon
authors.forename: Naven
authors.initials: N
authors.lastname: Chetty
authors.forename: Russell
authors.initials: R
authors.lastname: Land
authors.forename: Andrea
authors.initials: A
authors.lastname: Garrett
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009367:Neoplasm Staging; D049451:Nomograms; D011237:Predictive Value of Tests; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000473:pathology*