Development and validation of a nomogram based on multiple preoperative immunoinflammatory indexes for survival prediction in patients with stage IA-IB endometrial cancer

Nie Zhang; Hong Liu; Jiankang Yang; Fei Zhong

Development and validation of a nomogram based on multiple preoperative immunoinflammatory indexes for survival prediction in patients with stage IA-IB endometrial cancer

Am J Transl Res. 2023 Oct 15;15(10):6286-6298. eCollection 2023.

Authors

Nie Zhang^{1

2}, Hong Liu³, Jiankang Yang⁴, Fei Zhong²

Affiliations

¹ Graduate School of Anhui Medical University Hefei, Anhui, China.
² Department of Oncology, Fuyang Hospital of Anhui Medical University Fuyang, Anhui, China.
³ Department of Cardiovascular, Fuyang Hospital of Anhui Medical University Fuyang, Anhui, China.
⁴ Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University Hefei, Anhui, China.

PMID: 37969209
PMCID: PMC10641344

Abstract

Objectives: To evaluate the preoperative systemic immune-inflammation index (SII), advanced lung cancer inflammation index (ALI), neutrophil to lymphocyte ratio (NLR), and prognostic nutritional index (PNI) capacity to predict the prognosis of stage IA-IB endometrial carcinoma (EC) patients after operation, and establish a nomogram model to guide clinical practice.

Methods: A total of 387 patients with EC (R0 resection, stage IA-IB) were assessed. Clinical information and the SII, NLR, ALI, and PNI values were obtained. The low and high ratio groups were separated using the receiver operating characteristic curve (ROC). Pearson's χ²-test or Fisher's exact test was used to determine their relationship with clinical variables. To determine the independent prognostic factors, Cox regression was utilized to do the univariate and multivariate survival analyses. The Kaplan-Meier method was used to draw the survival curve in our survival analysis. Depending upon the independent prognostic factors, the nomogram for Overall survival (OS) and Disease-free survival (DFS) nomogram was developed, and its discrimination ability was validated by the consistency index (C-index) and calibration curve.

Results: Cox regression analysis revealed that FIGO staging, Ki-67 expression level, PNI, and ALI are independent prognostic factors for both OS and DFS. Then a novel predictive nomogram was developed, and its C-index value for OS and DFS was 0.829 and 0.814, respectively. The calibration curves demonstrated consistency amid the predicted prognosis using the developed nomogram and the actual observed outcomes.

Conclusions: The ALI and PNI could serve as readily available prognostic indicators for OS and DFS prediction in stage IA-IB EC patients. The nomogram developed owned superior power for OS and DFS prediction in stage IA-IB EC patients, and it would assist clinical oncologists in accurately predicting the individual's OS and DFS.

Keywords: Endometrial cancer; nomogram; preoperative immunoinflammatory index; prognostic prediction.