title: A Web-based nomogram predicting para-aortic nodal metastasis in incompletely staged patients with endometrial cancer: a Korean Multicenter Study.
abstract: OBJECTIVE
  The purpose of this study is to develop a Web-based nomogram for predicting the individualized risk of para-aortic nodal metastasis in incompletely staged patients with endometrial cancer.
  
  
  METHODS
  From 8 institutions, the medical records of 397 patients who underwent pelvic and para-aortic lymphadenectomy as a surgical staging procedure were retrospectively reviewed. A multivariate logistic regression model was created and internally validated by rigorous bootstrap resampling methods. Finally, the model was transformed into a user-friendly Web-based nomogram (http://http://www.kgog.org/nomogram/empa001.html).
  
  
  RESULTS
  The rate of para-aortic nodal metastasis was 14.4% (57/397 patients). Using a stepwise variable selection, 4 variables including deep myometrial invasion, non-endometrioid subtype, lymphovascular space invasion, and log-transformed CA-125 levels were finally adopted. After 1000 repetitions of bootstrapping, all of these 4 variables retained a significant association with para-aortic nodal metastasis in the multivariate analysis-deep myometrial invasion (P = 0.001), non-endometrioid histologic subtype (P = 0.034), lymphovascular space invasion (P = 0.003), and log-transformed serum CA-125 levels (P = 0.004). The model showed good discrimination (C statistics = 0.87; 95% confidence interval, 0.82-0.92) and accurate calibration (Hosmer-Lemeshow P = 0.74).
  
  
  CONCLUSIONS
  This nomogram showed good performance in predicting para-aortic metastasis in patients with endometrial cancer. The tool may be useful in determining the extent of lymphadenectomy after incomplete surgery.
authors.affiliation: *Center for Uterine Cancer, National Cancer Center, Goyang; †Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University; ‡Department of Obstetrics and Gynecology, Korea University College of Medicine; §Department of Obstetrics and Gynecology, Cancer Research Institute, College of Medicine, Seoul National University, Seoul; ∥Department of Obstetrics and Gynecology, Dongsan Medical Center, Keimyung University, Daegu; ¶Department of Obstetrics and Gynecology, Chonnam National University, Gwangju; #Department of Obstetrics and Gynecology, Gachon University Hospital, Incheon; and **Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University, Busan, South Korea.
authors.forename: Sokbom
authors.initials: S
authors.lastname: Kang
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Lee
authors.forename: Jae-Weon
authors.initials: JW
authors.lastname: Kim
authors.forename: Chi-Heum
authors.initials: CH
authors.lastname: Cho
authors.forename: Seok-Mo
authors.initials: SM
authors.lastname: Kim
authors.forename: Sang-Yoon
authors.initials: SY
authors.lastname: Park
authors.forename: Chan-Yong
authors.initials: CY
authors.lastname: Park
authors.forename: Ki-Tae
authors.initials: KT
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D049451:Nomograms; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult