External validation of a prognostic nomogram for overall survival in women with uterine leiomyosarcoma Journal Article


Authors: Iasonos, A.; Keung, E. Z.; Zivanovic, O.; Mancari, R.; Peiretti, M.; Nucci, M.; George, S.; Colombo, N.; Carinelli, S.; Hensley, M. L.; Raut, C. P.
Article Title: External validation of a prognostic nomogram for overall survival in women with uterine leiomyosarcoma
Abstract: BACKGROUND: There is no validated system to identify prognostically distinct cohorts of women with uterine leiomyosarcoma (ULMS). By using an independent, pooled, multi-institutional, international patient cohort, the authors validated a recently proposed ULMS nomogram. METHODS: The ULMS nomogram incorporated 7 clinical characteristics (age, tumor size, tumor grade, cervical involvement, locoregional metastases, distant metastases, and mitotic index (per 10 high-power fields) to predict overall survival (OS) after primary surgery. Independent cohorts from 2 sarcoma centers were included. Eligible women, at minimum, underwent a hysterectomy for primary, locally advanced, or metastatic ULMS and received part of their care at 1 of the centers between 1994 and 2010. RESULTS: In total, 187 women with ULMS were identified who met the above criteria described above (median age, 51 years; median tumor size, 9 cm; median mitotic index, 20 per 10 high-power fields). Tumors generally were high grade (88%), FIGO stage I or II (61%) without cervical involvement (93%) and without locoregional metastases (77%) or distant metastases (83%). The median OS and the 5-year OS rate were 4.5 years (95% confidence interval, 3.2-5.3 years) and 46%, respectively; and 65 women (35%) remained alive at last follow-up. The nomogram concordance index was 0.67(standard error, 0.02), which was as high as the concordance index from the initial cohort used for nomogram development. The concordance between actual OS and nomogram predictions suggests excellent calibration because predictions were within 1% of actual 5-year OS rates for patients with a predicted 5-year OS of less than 0.68. CONCLUSIONS: The ULMS nomogram was externally validated using independent cohorts. These findings support the international use of the ULMS nomogram prognostic of OS in ULMS. Cancer 2013. © 2012 American Cancer Society.
Keywords: staging; validation; nomogram; uterine leiomyosarcoma; international federation of gynecology and obstetrics and american joint committee on cancer
Journal Title: Cancer
Volume: 119
Issue: 10
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2013-05-15
Start Page: 1816
End Page: 1822
Language: English
DOI: 10.1002/cncr.27971
PROVIDER: scopus
PUBMED: 23456762
PMCID: PMC4044863
DOI/URL:
Notes: --- - "Export Date: 3 June 2013" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Alexia Elia Iasonos
    179 Iasonos
  2. Martee L Hensley
    220 Hensley