title: Just how accurate are the major risk stratification systems for early-stage endometrial cancer?
abstract: BACKGROUND
  To compare the accuracy of five major risk stratification systems (RSS) in classifying the risk of recurrence and nodal metastases in early-stage endometrial cancer (EC).
  
  
  METHODS
  Data of 553 patients with early-stage EC were abstracted from a prospective multicentre database between January 2001 and December 2012. The following RSS were identified in a PubMed literature search and included the Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC-1), the Gynecologic Oncology Group (GOG)-99, the Survival effect of para-aortic lymphadenectomy (SEPAL), the ESMO and the ESMO-modified classifications. The accuracy of each RSS was evaluated in terms of recurrence-free survival (RFS) and nodal metastases according to discrimination.
  
  
  RESULTS
  Overall, the ESMO -modified RSS provided the highest discrimination for both RFS and for nodal metastases with a concordance index (C-index) of 0.73 (95% CI, 0.70-0.76) and an area under the curve (AUC) of 0.80 (0.78-0.72), respectively. The other RSS performed as follows: the PORTEC1, GOG-99, SEPAL, ESMO classifications gave a C-index of 0.68 (0.66-0.70), 0.65 (0.63-0.67), 0.66 (0.63-0.69), 0.71 (0.68-0.74), respectively, for RFS and an AUC of 0.69 (0.66-0.72), 0.69 (0.67-0.71), 0.68 (0.66-0.70), 0.70 (0.68-0.72), respectively, for node metastases.
  
  
  CONCLUSIONS
  None of the five major RSS showed high accuracy in stratifying the risk of recurrence or nodal metastases in patients with early-stage EC, although the ESMO-modified classification emerged as having the highest power of discrimination for both parameters. Therefore, there is a need to revisit existing RSS using additional tools such as biological markers to better stratify risk for these patients.
authors: 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France [2] INSERM UMR S 707, 'Epidemiology, Information Systems, Modeling', University Pierre and Marie Curie, Paris 6, France.
authors: S
authors: S
authors: Bendifallah
authors: Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France.
authors: G
authors: G
authors: Canlorbe
authors: Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Lille, France.
authors: P
authors: P
authors: Collinet
authors: Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Lille, France.
authors: E
authors: E
authors: Arsène
authors: Department of Radiation Oncology, Tenon University Hospital, University Pierre and Marie Curie, Paris 6, France.
authors: F
authors: F
authors: Huguet
authors: Centre de lutte contre le cancer Georges François Leclerc, Dijon, France.
authors: C
authors: C
authors: Coutant
authors: Centre de lutte contre le cancer Georges François Leclerc, Dijon, France.
authors: D
authors: D
authors: Hudry
authors: Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
authors: O
authors: O
authors: Graesslin
authors: Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
authors: E
authors: E
authors: Raimond
authors: Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France.
authors: C
authors: C
authors: Touboul
authors: 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France [2] INSERM UMR S 938, University Pierre et Marie Curie, Paris 6, France.
authors: E
authors: E
authors: Daraï
authors: 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France [2] INSERM UMR S 938, University Pierre et Marie Curie, Paris 6, France.
authors: M
authors: M
authors: Ballester
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000145:classification / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D018570:Risk Assessment; D016019:Survival Analysis