title: External validation of a prognostic nomogram for overall survival in women with uterine leiomyosarcoma.
abstract: BACKGROUND
  There is no validated system to identify prognostically distinct cohorts of women with uterine leiomyosarcoma (ULMS). By using an independent, pooled, multi-institutional, international patient cohort, the authors validated a recently proposed ULMS nomogram.
  
  
  METHODS
  The ULMS nomogram incorporated 7 clinical characteristics (age, tumor size, tumor grade, cervical involvement, locoregional metastases, distant metastases, and mitotic index (per 10 high-power fields) to predict overall survival (OS) after primary surgery. Independent cohorts from 2 sarcoma centers were included. Eligible women, at minimum, underwent a hysterectomy for primary, locally advanced, or metastatic ULMS and received part of their care at 1 of the centers between 1994 and 2010.
  
  
  RESULTS
  In total, 187 women with ULMS were identified who met the above criteria described above (median age, 51 years; median tumor size, 9 cm; median mitotic index, 20 per 10 high-power fields). Tumors generally were high grade (88%), FIGO stage I or II (61%) without cervical involvement (93%) and without locoregional metastases (77%) or distant metastases (83%). The median OS and the 5-year OS rate were 4.5 years (95% confidence interval, 3.2-5.3 years) and 46%, respectively; and 65 women (35%) remained alive at last follow-up. The nomogram concordance index was 0.67(standard error, 0.02), which was as high as the concordance index from the initial cohort used for nomogram development. The concordance between actual OS and nomogram predictions suggests excellent calibration because predictions were within 1% of actual 5-year OS rates for patients with a predicted 5-year OS of less than 0.68.
  
  
  CONCLUSIONS
  The ULMS nomogram was externally validated using independent cohorts. These findings support the international use of the ULMS nomogram prognostic of OS in ULMS.
authors: Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. iasonosa@mskcc.org
authors: Alexia
authors: A
authors: Iasonos
authors: Emily Z
authors: EZ
authors: Keung
authors: Oliver
authors: O
authors: Zivanovic
authors: Rosanna
authors: R
authors: Mancari
authors: Michele
authors: M
authors: Peiretti
authors: Marisa
authors: M
authors: Nucci
authors: Suzanne
authors: S
authors: George
authors: Nicoletta
authors: N
authors: Colombo
authors: Silvestro
authors: S
authors: Carinelli
authors: Martee L
authors: ML
authors: Hensley
authors: Chandrajit P
authors: CP
authors: Raut
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007391:International Cooperation; D053208:Kaplan-Meier Estimate; D007890:Leiomyosarcoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D008940:Mitotic Index; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D049451:Nomograms; D011379:Prognosis; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery