Prognostic-Related Metabolic Score for Survival Prediction in Early-Stage Endometrioid Endometrial Cancer: A Multi-Center and Retrospective Study

Zizhuo Wang; Kun Song; Jingbo Liu; Qing Zhang; Chuyao Zhang; Beibei Wang; Yu Fu; Yu Wang; Shuzhong Yao; Congjian Xu; Min Xia; Ge Lou; Jihong Liu; Bei Lin; Jianliu Wang; Weidong Zhao; Jieqing Zhang; Wenjun Cheng; Hongyan Guo; Ruixia Guo; Fengxia Xue; Xipeng Wang; Lili Han; Xia Zhao; Xiaomao Li; Ping Zhang; Jianguo Zhao; Jiezhi Ma; Qin Yao; Wenting Li; Xiaohang Yang; Yong Fang; Gang Chen; Kezhen Li; Yuanming Shen; Chaoyang Sun; Beihua Kong

doi:10.3389/fmed.2022.830673

Prognostic-Related Metabolic Score for Survival Prediction in Early-Stage Endometrioid Endometrial Cancer: A Multi-Center and Retrospective Study

Front Med (Lausanne). 2022 Apr 28:9:830673. doi: 10.3389/fmed.2022.830673. eCollection 2022.

Authors

Zizhuo Wang^{1

2}, Kun Song³, Jingbo Liu^{1

2}, Qing Zhang³, Chuyao Zhang⁴, Beibei Wang^{1

2}, Yu Fu^{1

2}, Yu Wang⁵, Shuzhong Yao⁶, Congjian Xu⁷, Min Xia⁸, Ge Lou⁹, Jihong Liu⁴, Bei Lin¹⁰, Jianliu Wang¹¹, Weidong Zhao¹², Jieqing Zhang¹³, Wenjun Cheng¹⁴, Hongyan Guo¹⁵, Ruixia Guo¹⁶, Fengxia Xue¹⁷, Xipeng Wang¹⁸, Lili Han¹⁹, Xia Zhao²⁰, Xiaomao Li²¹, Ping Zhang²², Jianguo Zhao^{23

24

25}, Jiezhi Ma²⁶, Qin Yao²⁷, Wenting Li^{1

2}, Xiaohang Yang^{1

2}, Yong Fang^{1

2}, Gang Chen^{1

2}, Kezhen Li^{1

2}, Yuanming Shen⁵, Chaoyang Sun^{1

2}, Beihua Kong³

Affiliations

¹ Key Laboratory of the Ministry of Education, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
⁴ Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
⁵ Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁶ Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
⁷ Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
⁸ Department of Obstetrics and Gynecology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
⁹ Department of Gynecology Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
¹⁰ Department of Obstetrics and Gynecology, ShengJing Hospital of China Medical University, Shenyang, China.
¹¹ Peking University People's Hospital, Beijing, China.
¹² Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.
¹³ Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, China.
¹⁴ The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
¹⁵ Peking University Third Hospital, Beijing, China.
¹⁶ Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
¹⁷ Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin, China.
¹⁸ Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁹ Department of Gynecology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, China.
²⁰ Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, China.
²¹ Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
²² Department of Gynecology, The Second Hospital of Shandong University, Jinan, China.
²³ Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Affiliated Hospital of Nankai University, Tianjin, China.
²⁴ Tianjin Clinical Research Center for Gynecology and Obstetrics, Tianjin, China.
²⁵ Branch of National Clinical Research Center for Gynecology and Obstetrics, Tianjin, China.
²⁶ Department of Obstetrics and Gynecology, The Third Xiangya Hospital, Central South University, Changsha, China.
²⁷ Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China.

Abstract

Objective: Patients with endometrial cancer (EC) combined with metabolic syndrome (MetS) have a worse prognosis than those without MetS. This study aimed to investigate whether partial metabolic disorder significantly influenced early-stage endometrioid EC (EEC) survival and searched for a more efficient method to evaluate metabolic status.

Methods: This is a nationwide, multicenter cohort study that included 998 patients with primary early-stage EEC from 2001 to 2018. Patients were divided into different metabolic groups based on the diagnostic criteria of the Chinese Medical Association (CDC). The progression-free survival (PFS) time was compared between various metabolic status. Meanwhile, we established an EC Prognostic-Related Metabolic Score (ECPRM Score) to explore the association of the severity of metabolic status and early-stage EEC PFS. A nomogram was established for predicting PFS, which was externally validated in a testing set that includes 296 patients.

Results: A partial metabolic disorder, as well as MetS, was an independent risk factor of poor survival of patients with early-stage EEC [hazard ratio (HR) = 7.6, 95% CI = 1.01-57.5, p < 0.05]. A high ECPRM Score was associated with lower PFS (HR = 2.1, 95% CI = 1.05-4.0, p < 0.001). The nomogram, in which the ECPRM Score contributed most to the prognosis, exhibited excellent discrimination of survival supported by the internal and external validations. In addition, the calibration curve supports its robust predicting ability.

Conclusion: Even though they do not meet the criteria of MetS, partial metabolic disorders were also associated with adverse outcomes in early-stage EEC. The ECPRM Score is beneficial for clinicians to evaluate the severity of metabolic abnormalities and guide patients to ameliorate the poor prognosis of metabolic disorders.

Keywords: ECPRM Score; early-stage endometrioid endometrial cancer; metabolic status; partial metabolic disorders; progression-free survival time.

Copyright © 2022 Wang, Song, Liu, Zhang, Zhang, Wang, Fu, Wang, Yao, Xu, Xia, Lou, Liu, Lin, Wang, Zhao, Zhang, Cheng, Guo, Guo, Xue, Wang, Han, Zhao, Li, Zhang, Zhao, Ma, Yao, Li, Yang, Fang, Chen, Li, Shen, Sun and Kong.