Classification and regression tree (CART) analysis of endometrial carcinoma: Seeing the forest for the trees Journal Article


Authors: Barlin, J. N.; Zhou, Q.; St. Clair, C. M.; Iasonos, A.; Soslow, R. A.; Alektiar, K. M.; Hensley, M. L.; Leitao, M. M. Jr; Barakat, R. R.; Abu-Rustum, N. R.
Article Title: Classification and regression tree (CART) analysis of endometrial carcinoma: Seeing the forest for the trees
Abstract: Objective The objectives of the study are to evaluate which clinicopathologic factors influenced overall survival (OS) in endometrial carcinoma and to determine if the surgical effort to assess para-aortic (PA) lymph nodes (LNs) at initial staging surgery impacts OS. Methods All patients diagnosed with endometrial cancer from 1/1993-12/2011 who had LNs excised were included. PALN assessment was defined by the identification of one or more PALNs on final pathology. A multivariate analysis was performed to assess the effect of PALNs on OS. A form of recursive partitioning called classification and regression tree (CART) analysis was implemented. Variables included: age, stage, tumor subtype, grade, myometrial invasion, total LNs removed, evaluation of PALNs, and adjuvant chemotherapy. Results The cohort included 1920 patients, with a median age of 62 years. The median number of LNs removed was 16 (range, 1-99). The removal of PALNs was not associated with OS (P = 0.450). Using the CART hierarchically, stage I vs. stages II-IV and grades 1-2 vs. grade 3 emerged as predictors of OS. If the tree was allowed to grow, further branching was based on age and myometrial invasion. Total number of LNs removed and assessment of PALNs as defined in this study were not predictive of OS. Conclusion This innovative CART analysis emphasized the importance of proper stage assignment and a binary grading system in impacting OS. Notably, the total number of LNs removed and specific evaluation of PALNs as defined in this study were not important predictors of OS. © 2013 Elsevier Inc. All rights reserved.
Keywords: adolescent; adult; child; controlled study; human tissue; preschool child; school child; aged; aged, 80 and over; middle aged; retrospective studies; young adult; major clinical study; overall survival; histopathology; cancer growth; cancer adjuvant therapy; chemotherapy, adjuvant; radiotherapy, adjuvant; cancer staging; endometrial cancer; staging; cancer diagnosis; endometrium carcinoma; hysterectomy; paraaortic lymph node; endometrial neoplasms; lymph nodes; lymphatic metastasis; neoplasm staging; cancer grading; lymph node excision; cohort analysis; carcinoma; neoplasm invasiveness; age distribution; cancer classification; regression analysis; aorta; tumor invasion; adnexectomy; lymph vessel metastasis; cart analysis; classification and regression tree analysis; classification and regression tree
Journal Title: Gynecologic Oncology
Volume: 130
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2013-09-01
Start Page: 452
End Page: 456
Language: English
DOI: 10.1016/j.ygyno.2013.06.009
PROVIDER: scopus
PMCID: PMC3748179
PUBMED: 23774300
DOI/URL:
Notes: --- - "Export Date: 1 October 2013" - "CODEN: GYNOA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Richard R Barakat
    625 Barakat
  2. Kaled M Alektiar
    260 Alektiar
  3. Mario Leitao
    323 Leitao
  4. Joyce Nuqui Barlin
    23 Barlin
  5. Qin Zhou
    128 Zhou
  6. Alexia Elia Iasonos
    191 Iasonos
  7. Martee L Hensley
    229 Hensley
  8. Robert Soslow
    667 Soslow