Prognostic index models in stage I and II endometrial carcinoma

In most studies, authors recommend the use of independent variables in clinical decision-making, but no guidelines are given about how to use all the extracted information.

By combining two or three prognostically independent variables and using their relative prognostic impact (results from Cox analyses), a novel way of identifying high- and low-risk groups was developed. A total of 336 women with stage I-II endometrial carcinoma of medium or high risk were included. Twenty-one clinico- pathological variables, were initially studied in univariate analyses and significant variables were used for the construction of prognostic indices. Six prognostic indices were constructed, which then were used to calculate individual index values for each patient.

The index values were highly prognostic and used for the identification of a limited high-risk group (10% of the patients) and a large low-risk group (90% of the patients). Indices 1-3 were constructed for pre-treatment situations and included age, degree of differentiation, nuclear grade and S-phase fraction in various combinations. They identified a high- and a low-risk group with a 5-year disease-specific survival of 31-37% and 74.79%, respectively. Indices 4 and 5 were constructed using variables available after treatment and index 6 for patients with no evidence of disease (NED) after treatment completion. The 5-year survival for the latter indices were 30-52% and 75-85%, respectively.

The use of prognostic indices in different clinical situations was generally superior to the use of single variables for the identification of well-defined high- and low-risk groups.