A Web-Based Nomogram Predicting Para-aortic Nodal Metastasis in Incompletely Staged Patients With Endometrial Cancer: A Korean Multicenter Study

Abstract

ObjectiveThe 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.MethodsFrom 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://www.kgog.org/nomogram/empa001.html).ResultsThe 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-LemeshowP= 0.74).ConclusionsThis 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.