目的:对于患有低风险子宫内膜癌(EC)的生殖患者,可能会考虑保留生育力治疗(FST)。另一方面,低危EC患者术前评估和术后病理的匹配率不够高.我们旨在根据低危EC患者的术前肌层浸润(MI)和分级来预测术后病理,以帮助扩展FST的当前标准。
方法:韩国妇科肿瘤组2015的辅助研究(KGOG2015S),前瞻性,多中心研究包括术前MRI检查无MI或MI<1/2、子宫内膜样腺癌和子宫内膜活检检查为1级或2级的患者。在符合条件的患者中,第1-4组分别定义为无MI和1级,无MI和2级,MI<1/2和1级,MI<1/2和2级。使用机器学习开发了新的预测模型。
结果:在251名符合条件的患者中,第1-4组包括106、41、74和30名患者,分别。新的预测模型显示出优于常规分析的预测值。在新的预测模型中,最好的净现值,灵敏度,术前各组预测术后各组的AUC如下:87.2%,71.6%,和0.732(第1组);97.6%,78.6%,和0.656(第二组);71.3%,78.6%和0.588(第3组);91.8%,64.9%,和0.676%(第4组)。
结论:在低风险EC患者中,术后病理预测无效,但是新的预测模型提供了更好的预测。
OBJECTIVE: Fertility-sparing treatment (FST) might be considered an option for reproductive patients with low-risk endometrial cancer (EC). On the other hand, the matching rates between preoperative assessment and postoperative pathology in low-risk EC patients are not high enough. We aimed to predict the postoperative pathology depending on preoperative myometrial invasion (MI) and grade in low-risk EC patients to help extend the current criteria for FST.
METHODS: This ancillary study (KGOG 2015S) of Korean Gynecologic Oncology Group 2015, a prospective, multicenter study included patients with no MI or MI <1/2 on preoperative MRI and endometrioid adenocarcinoma and grade 1 or 2 on endometrial biopsy. Among the eligible patients, Groups 1-4 were defined with no MI and grade 1, no MI and grade 2, MI <1/2 and grade 1, and MI <1/2 and grade 2, respectively. New prediction models using machine learning were developed.
RESULTS: Among 251 eligible patients, Groups 1-4 included 106, 41, 74, and 30 patients, respectively. The new prediction models showed superior prediction values to those from conventional analysis. In the new prediction models, the best NPV, sensitivity, and AUC of preoperative each group to predict postoperative each group were as follows: 87.2%, 71.6%, and 0.732 (Group 1); 97.6%, 78.6%, and 0.656 (Group 2); 71.3%, 78.6% and 0.588 (Group 3); 91.8%, 64.9%, and 0.676% (Group 4).
CONCLUSIONS: In low-risk EC patients, the prediction of postoperative pathology was ineffective, but the new prediction models provided a better prediction.