title: A Predictive Model Using Histopathologic Characteristics of Early-Stage Type 1 Endometrial Cancer to Identify Patients at High Risk for Lymph Node Metastasis.
abstract: BACKGROUND
  This study aimed to develop a predictive model using histopathologic characteristics of early-stage type 1 endometrial cancer (EC) to identify patients at high risk for lymph node (LN) metastases.
  
  
  METHODS
  The data of 523 patients who received primary surgical treatment between January 2001 and December 2012 were abstracted from a prospective multicenter database (training set). A multivariate logistic regression analysis of selected prognostic features was performed to develop a nomogram predicting LN metastases. To assess its accuracy, an internal validation technique with a bootstrap approach was adopted. The optimal threshold in terms of clinical utility, sensitivity, specificity, negative predictive values (NPVs), and positive predictive values (PPVs) was evaluated by the receiver-operating characteristics (ROC) curve area and the Youden Index.
  
  
  RESULTS
  Overall, the LN metastasis rate was 12.4 % (65/523). Lymph node metastases were associated with histologic grade, tumor diameter, depth of myometrial invasion, and lymphovascular space involvement status. These variables were included in the nomogram. Discrimination of the model was 0.83 [95 % confidence interval (CI) 0.80-0.85] in the training set. The area under the curve ROC for predicting LN metastases after internal validation was 0.82 (95 % CI 0.80-0.84). The Youden Index provided a value of 0.2, corresponding to a cutoff of 140 points (total score in the algorithm). At this threshold, the model had a sensitivity of 0.73 (95 % CI 0.62-0.83), a specificity of 0.84 (95 % CI 0.82-0.85), a PPV of 0.40 (95 % CI 0.34-0.45), and an NPV of 0.95 (95 % CI 0.94-0.97).
  
  
  CONCLUSIONS
  The results show that the risk of LN metastases can be predicted correctly so that patients at high risk can benefit from adapted surgical treatment.
authors: Department of Obstetrics and Gynaecology, Tenon University Hospital, University Pierre and Marie Curie, Paris 6, France. sofiane.bendifallah@yahoo.fr.|INSERM UMR S 707, "Epidemiology, Information Systems, Modeling", University Pierre and Marie Curie, Paris, France. sofiane.bendifallah@yahoo.fr.
authors: Sofiane
authors: S
authors: Bendifallah
authors: Department of Obstetrics and Gynaecology, Tenon University Hospital, University Pierre and Marie Curie, Paris 6, France.
authors: Geoffroy
authors: G
authors: Canlorbe
authors: Department of Obstetrics and Gynaecology, Tenon University Hospital, University Pierre and Marie Curie, Paris 6, France.
authors: Enora
authors: E
authors: Laas
authors: Department of Radiation Oncology, Tenon University Hospital, University Pierre and Marie Curie, Paris 6, France.
authors: Florence
authors: F
authors: Huguet
authors: Centre de Lutte Contre le Cancer Georges François Leclerc, Dijon, France.
authors: Charles
authors: C
authors: Coutant
authors: Centre de Lutte Contre le Cancer Georges François Leclerc, Dijon, France.
authors: Delphine
authors: D
authors: Hudry
authors: Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
authors: Olivier
authors: O
authors: Graesslin
authors: Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
authors: Emilie
authors: E
authors: Raimond
authors: Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France.
authors: Cyril
authors: C
authors: Touboul
authors: Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Lille, France.
authors: Pierre
authors: P
authors: Collinet
authors: Department of Pathology, Tenon University Hospital, University Pierre and Marie Curie, Paris, France.
authors: Annie
authors: A
authors: Cortez
authors: Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Lille, France.
authors: Géraldine
authors: G
authors: Bleu
authors: Department of Obstetrics and Gynaecology, Tenon University Hospital, University Pierre and Marie Curie, Paris 6, France.|INSERM UMR S 938, University Pierre et Marie Curie, Paris 6, France.|Institut Universitaire de Cancérologie (IUC), University Pierre and Marie Curie, Paris 6, France.
authors: Emile
authors: E
authors: Daraï
authors: Department of Obstetrics and Gynaecology, Tenon University Hospital, University Pierre and Marie Curie, Paris 6, France.|INSERM UMR S 938, University Pierre et Marie Curie, Paris 6, France.|Institut Universitaire de Cancérologie (IUC), University Pierre and Marie Curie, Paris 6, France.
authors: Marcos
authors: M
authors: Ballester
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D008962:Models, Theoretical; D009215:Myometrium / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D049451:Nomograms; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D015996:Survival Rate; D047368:Tumor Burden