Construction Of A Prediction Model For The Risk Of Lymphovascular Space Invasion In Endomeyrial Cancer

Background:Endometrial carcinoma(EC)is a common malignant tumor in the female reproductive system,which usually has a good prognosis in the early stage,and when the tumor spreads to involve the lymph nodes,the patient survival rate will be significantly reduced.Preoperative evaluation of lymph node status is an important reference content for comprehensive staging surgery for endometrial cancer.Studies have shown that Lymphovascular space invasion(LVSI)is a prerequisite for lymph node metastasis,and its presence indicates an increased risk of lymph node metastasis,which provides an important reference for preoperative assessment of lymph node status.Moreover,in the European Society for Medical Oncology(ESMO),LVSI is used as the determinant of risk stratification of low-risk endometrial cancer,which directly affects the decision of intraoperative lymph node resection.However,the current status of LVSI can only be known after postoperative routine pathology,and clinically,there is still a lack of accurate and effective biomarkers to accurately judge them before surgery.In recent years,predictive models can be used to assess the risk of disease and are widely used in clinical practice.However,there are relatively few studies on LVSI prediction models for endometrial cancer at home and abroad.Objective:The relevant risk factors affecting the development of LVSI in endometrial cancer patients were explored,the independent risk factors were selected as predictors,and the LVSI risk prediction model for endometrial cancer was constructed as an auxiliary means to provide individualized evaluation for clinical diagnosis and treatment.Methods:A total of 236 eligible patients were hospitalized in the Department of Obstetrics and Gynecology of Henan University from January 2018 to June 2022 of the First Affiliated Hospital of Henan University and confirmed as endometrial cancer.Relevant clinical data of the above patients were collected,and the patients were divided into LVSI negative group(n=176)and LVSI positive group(n=60)according to the postoperative pathology.Univariate analysis of two clinical data was performed using SPSS 23.0 software,and statistically significant indicators of univariate analysis were included in multivariate Logistic regression analysis to identify independent risk factors for LVSI in endometrial cancer.Nomogram to predict the risk of endometrial cancer LVSI using independent risk factors using R software.The consistency index(C-index)is evaluated;the model is internally verified by Bootstrap self-sampling;and then the clinical application value of the model is evaluated by drawing the clinical decision curve(DCA).Results.1.Univariate analysis results showed histological grade(P<0.001),muscle layer invasion depth(P<0.001),fibrinogen ≥ 3.38g/L(P<0.001),MLR ≥ 0.24(P<0.001),tumor diameter(P=0.004),cervical stromal involvement(P=0.007),pathological type(P<0.001),and lymph node metastases(P=0.036)between LVSI negative and positive groups(P<0.05).2.The ROC curve showed the AUC of fibrinogen of 0.761 and the optimal cutoff of 3.38g/L,corresponding to 73.4%,a sensitivity of 77.6%;AUC of MLR of 0.707 and the optimal cutoff of 0.24,corresponding to a sensitivity of 70.3% and 69.8%.3.Multivariate analysis showed that the depth of muscle layer infiltration was ≥ 1/2(OR=4.637,95%CI:1.895-11.344),fibrinogen≥3.38g/L(OR=4.150,95%CI:1.658-10.389),MLR≥0.24(OR=3.579,95%CI:1.467-8.731),low differentiation(OR=3.550,95%CI:1.346-9.363)and non-endometrioid carcinoma(OR=3.195,95%CI:1.017-10.038)is an independent risk factor for LVSI in endometrial cancer patients.4.The C-index of the LVSI risk prediction model for endometrial cancer is 0.899,which indicates the good prediction ability of the model;using the Bootstrap self-sampling(B=1000)method,the C-index is 0.869;the average absolute error of the calibration curve is 0.033,indicating that the model has good calibration ability,and the clinical utility value suggests the model.Conclusions.1.Fibrinogen≥3.38g/L,poorly differentiated,MLR≥0.24,depth of myometrial invasion≥1/2,and non-endotrioid adenocarcinoma are independent risk factors for LVSI in endometrial cancer patients.2.The LVSI risk prediction model for endometrial cancer constructed in this study has good predictive ability,and can be used as an auxiliary means to provide reference for preoperative assessment of lymph node status and help clinicians to develop more precise individualized treatment plans.