Yu-Che Ou

Integration of pretreatment tumor markers in a nomogram model for prognostic prediction of FIGO stage I endometrial cancer: A multi‐institutional cohort study

AbstractObjectiveTraditionally, the prognosis of patients with FIGO stage I endometrial cancer is determined by clinicopathological risk factors. In this study, we assessed the potential contribution of pretreatment carcinoembryonic antigen (CEA) and carbohydrate antigen‐125 (CA‐125) levels to estimating the prognosis of these patients and aimed to develop and validate a prognostic nomogram.MethodsThis retrospective study included patients with FIGO stage I endometrial cancer who underwent treatment between January 2009 and December 2021 in the four institutes of Chang Gung Memorial Hospital. To identify optimal cutoff values of CEA and CA‐125 for predicting survival, receiver operating characteristic (ROC) curves were generated, the Kaplan–Meier method was used to estimate survival, and a Cox regression model was used to analyze the independent prognostic factors. Finally, a nomogram and calibration curve were constructed to predict patient survival probability.ResultsOf the 1559 patients evaluated, the optimal cutoff values of CEA and CA‐125 were 1.44 ng/mL (area under the ROC curve [AUC] 0.601) and 39.77 U/mL (AUC 0.503), respectively. Multivariate Cox regression analysis showed that pretreatment CEA (hazard ratio [HR] 2.11, 95% confidence interval [95% CI] 1.35–3.28), CA‐125 (HR 2.07, 95% CI 1.31–3.27), age >70 years (HR 12.54, 95% CI 5.05–31.11), myometrial invasion >50% (HR 1.69, 95% CI 1.03–2.73), non‐endometrioid histology (HR 1.83, 95% CI 1.14–2.95), high‐grade tumor (HR 2.41, 95% CI 1.46–3.97), and lymphovascular space invasion (HR 2.32, 95% CI 1.26–4.25) were significant variables associated with overall survival. These factors were used to construct the nomogram model, which showed good concordance and accuracy.ConclusionsIntegration of pretreatment CEA and CA‐125 in a prognostic nomogram is feasible. Our prediction model has the potential to assist clinicians in guiding appropriate clinical practice.

External validation of CEA and CA125 prediction model for lymph node metastasis in endometrial cancer: A multi-institute cohort study

Background We previously utilized pretreatment tumor markers Carcinoembryonic Antigen (CEA) and Cancer Antigen 125 (CA125) for predicting lymph node metastasis (LNM) in endometrioid endometrial cancer (EC). Objective The aim of this study was to externally validate a nomogram developed in our previous single-center retrospective study. Methods A multi-center validation study was conducted to recruit endometrioid EC patients from four branches of Chang Gung Memorial Hospital between 2009 and 2021, with patients participating in the original research being excluded. The previously established nomogram was applied with optimal cut-off values for CEA 1.4 ng/ml and CA125 40 U/mL identified through receiver operating characteristic (ROC) curves. The concordance index (C-index) was calculated to assess discrimination, and comparative negative predictive value (NPV) and negative likelihood ratio (NLR) were determined. Decision curve analysis (DCA) was plotted to evaluate our predictive model's clinical utility and net benefit. Results Overall, 1271 patients were included in this external validation study. The results demonstrated a C-index of 0.727, indicating moderate discrimination ability of the nomogram in predicting LNM in this independent cohort. Comparative analysis of NPV 97.2% and NLR 0.36 revealed performance metrics consistent with the original study, reinforcing the nomogram's potential clinical utility in ruling out the possibility of LNM if both pretreatment CEA and CA125 were less than 1.4 ng/ml and 40 U/mL, respectively. The DCA indicated that the nomogram provided clinical utility. Conclusion The reproducible performance metrics in the independent large sample cohort underscore the robustness and generalizability of utilizing CEA and CA125 as predictors of LNM in endometrioid EC, suggesting its potential as a simple tool for clinicians in preoperative decision-making regarding lymphadenectomy.

Does repetitive dilatation and curettage or hysteroscopic biopsy in patients treated with progestins for endometrial hyperplasia or carcinoma affect subsequent fetomaternal outcomes? A population‐based study using the National Health Insurance Research Database of Taiwan

AbstractObjectiveTo investigate the impact of repeated dilatation and curettage or hysteroscopic biopsy on fetomaternal outcomes in patients receiving progestin treatment for endometrial hyperplasia or early‐stage carcinoma.MethodThis was a population‐based study using the Taiwan National Health Insurance Research Database between 2009 and 2017 of women who gave birth and had a history of endometrial hyperplasia and early‐stage carcinoma treated with progestins. Logistic regression analysis was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) reflecting the association between repeated procedures and fetomaternal outcomes.ResultsA total of 6956 women with 8690 deliveries were identified. Compared with those who had two or fewer procedures, women who received more than two procedures had a significantly higher risk for cervical insufficiency (aOR, 5.09 [95 CI, 2.31–11.24]). Furthermore, women who had more than two procedures were prone to have adverse neonatal outcomes, including Apgar score < 7 at 1 min (aOR, 1.97 [95% CI, 1.13–3.43]) and 5 min (aOR, 3.11 [95% CI, 1.33–7.23]) and preterm delivery <32 weeks (aOR, 2.86 [95% CI, 1.50–5.45]).ConclusionUndergoing more than two procedures was associated with subsequent maternal cervical insufficiency, preterm delivery <32 weeks, and low neonatal Apgar score. Health care providers should be aware of the potential risks and balance the benefits and harms of repeated procedures.

Elevated urinary phthalate levels in endometrial cancer patients: Evidence from a comparative study

Phthalates are common plasticizers with endocrine-disrupting properties. Although laboratory studies suggest links to estrogen-dependent cancers, their association with endometrial cancer (EC) in humans remains unclear. This study investigated urinary phthalate metabolite levels in relation to EC and explored potential lifestyle and dietary contributors to phthalate exposure. A total of 232 women, including 116 EC patients and 116 healthy controls, were enrolled. Urine samples were analyzed by UPLC-MS/MS to measure eight phthalate metabolites, adjusted for creatinine. Lifestyle and dietary information were collected via questionnaires. Logistic regression assessed associations between phthalate levels and EC, while Spearman's correlation examined inter-metabolite relationships. All eight metabolites were detected in over 90 % of participants, with significantly higher concentrations in the EC group. Among them, mono-benzyl phthalate (MBzP) was the only metabolite independently associated with EC (OR 3.712, 95 % CI 1.464-9.414, p = 0.006). Using a cutoff value of 0.145 µg/g Cr, EC remained the only independent predictor of elevated MBzP levels (OR 5.696, 95 % CI 2.572-12.615, p < 0.001). No significant associations were found between MBzP levels and lifestyle or dietary habits. Correlations among phthalate metabolites were generally consistent across groups, though MBzP showed weaker correlations, indicating potentially distinct exposure pathways. This study is the first to demonstrate an independent link between urinary MBzP levels and EC in humans. The lack of lifestyle or dietary influence highlights the complexity of exposure sources, emphasizing the need for further research to understand underlying mechanisms and environmental factors contributing to phthalate exposure.