Development and Validation of a Nomogram Prediction Model for Endometrial Malignancy in Patients with Abnormal Uterine Bleeding
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Purpose: This study aimed to identify the risk factors and sonographic variables that could be integrated into a predictive model for endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) in women with abnormal uterine bleeding (AUB). Materials and Methods: This retrospective study included 1837 patients who presented with AUB and underwent endometrial sampling. Multivariable logistic regression was developed based on clinical and sonographic covariates [endometrial thickness (ET), resistance index (RI) of the endometrial vasculature] assessed for their association with EC/AEH in the development group (n=1369), and a predictive nomogram was proposed. The model was validated in 468 patients. Results: Histological examination revealed 167 patients (12.2%) with EC or AEH in the development group. Using multivariable logistic regression, the following variables were incorporated in the prediction of endometrial malignancy: metabolic diseases [odds ratio (OR)=7.764, 95% confidence intervals (CI) 5.042–11.955], family history (OR=3.555, 95% CI 1.055–11.971), age ≥40 years (OR=3.195, 95% CI 1.878–5.435), RI ≤0.5 (OR=8.733, 95% CI 4.311–17.692), and ET ≥10 mm (OR=8.479, 95% CI 5.440–13.216). A nomogram was created using these five variables with an area under the curve of 0.837 (95% CI 0.800–0.874). The calibration curve showed good agreement between the observed and predicted occurrences. For the validation group, the model provided acceptable discrimination and calibration. Conclusion: The proposed nomogram model showed moderate prediction accuracy in the differentiation between benign and malignant endometrial lesions among women with AUB.
Abstract
Purpose: This study aimed to identify the risk factors and sonographic variables that could be integrated into a predictive model for endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) in women with abnormal uterine bleeding (AUB). Materials and Methods: This retrospective study included 1837 patients who presented with AUB and underwent endometrial sampling. Multivariable logistic regression was developed based on clinical and sonographic covariates [endometrial thickness (ET), resistance index (RI) of the endometrial vasculature] assessed for their association with EC/AEH in the development group (n=1369), and a predictive nomogram was proposed. The model was validated in 468 patients. Results: Histological examination revealed 167 patients (12.2%) with EC or AEH in the development group. Using multivariable logistic regression, the following variables were incorporated in the prediction of endometrial malignancy: metabolic diseases [odds ratio (OR)=7.764, 95% confidence intervals (CI) 5.042–11.955], family history (OR=3.555, 95% CI 1.055–11.971), age ≥40 years (OR=3.195, 95% CI 1.878–5.435), RI ≤0.5 (OR=8.733, 95% CI 4.311–17.692), and ET ≥10 mm (OR=8.479, 95% CI 5.440–13.216). A nomogram was created using these five variables with an area under the curve of 0.837 (95% CI 0.800–0.874). The calibration curve showed good agreement between the observed and predicted occurrences. For the validation group, the model provided acceptable discrimination and calibration. Conclusion: The proposed nomogram model showed moderate prediction accuracy in the differentiation between benign and malignant endometrial lesions among women with AUB.
참고문헌 (19)
- Pennant ME, "Premenopausal abnormal uterine bleeding and risk of endometrial cancer", BJOG, 124, pp.404~411 (2017)
- Clarke MA, "Association of endometrial cancer risk with postmenopausal bleeding in women : a systematic review and meta-analysis", JAMA Intern Med, 178, pp.1210~1222 (2018)
- Committee on Gynecologic Practice, "The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding", Obstet Gynecol, 131, pp.e124~e129 (2018)
- 김민정, "Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women", Obstetrics & Gynecology Science, 59(3), pp.192~200 (2016), 대한산부인과학회[DOI]
- Kumari P, "Endometrial cut off thickness as predictor of endometrial pathology in perimenopausal women with abnormal uterine bleeding : a cross-sectional study", Obstet Gynecol Int, 2022, pp.5073944~ (2022)
- Alblas M, "Prediction models for endometrial cancer for the general population or symptomatic women : a systematic review", Crit Rev Oncol Hematol, 126, pp.92~99 (2018)
- Sarink D, "Racial", ethnic differences in anthropometric and hormone-related factors and endometrial cancer risk : the Multiethnic Cohort Study, 2021, pp.124, 1724~1733
- Timmermans A, "Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding : a systematic review and meta-analysis", Obstet Gynecol, 116, pp.160~167 (2010)
- Giannella L, "Prediction of endometrial hyperplasia and cancer among premenopausal women with abnormal uterine bleeding", Biomed Res Int, 2019, pp.8598152~ (2019)
- Heremans R, "Ultrasound features of endometrial pathology in women without abnormal uterine bleeding : results from the international endometrial tumor analysis study(IETA3)", Ultrasound Obstet Gynecol, 60, pp.243~255 (2022)
- Nasheeha N, "Diagnostic accuracy of uterine artery and spiral artery Doppler for evaluation of endometrial pathology in postmenopausal bleeding", J Gynecol Obstet Hum Reprod, 50, pp.102209~ (2021)
- Dueholm M, "An ultrasound algorithm for identification of endometrial cancer", Ultrasound Obstet Gynecol, 43, pp.557~568 (2014)
- Zhang H, "Correlation of metabolic factors with endometrial atypical hyperplasia and endometrial cancer : development and assessment of a new predictive nomogram", Cancer Manag Res, 13, pp.7937~7949 (2021)
- Yang X, "The role of metabolic syndrome in endometrial cancer : a review", Front Oncol, 9, pp.744~ (2019)
- Sangam Jha, "Rate of premalignant and malignant endometrial lesion in “low-risk” premenopausal women with abnormal uterine bleeding undergoing endometrial biopsy", Obstetrics & Gynecology Science, 64(6), pp.517~523 (2021), 대한산부인과학회
- Corbacioglu Esmer A, "Is there an appropriate cutoff age for sampling the endometrium in premenopausal bleeding?", Gynecol Obstet Invest, 77, pp.40~44 (2014)
- Papakonstantinou E, "Management of pre-, peri-, and post-menopausal abnormal uterine bleeding: when to perform endometrial sampling?", Int J Gynaecol Obstet, 158, pp.252~259 (2022)
- Raglan O, "Risk factors for endometrial cancer : an umbrella review of the literature", Int J Cancer, 145, pp.1719~1730 (2019)
- Ali AT, "Reproductive factors and the risk of endometrial cancer", Int J Gynecol Cancer, 24, pp.384~393 (2014)