Abstract
Purpose: This study aimed to investigate the association of metabolic factors with endometrial atypical hyperplasia and endometrial cancer, and to develop a Nomogram model to predict the risk of developing endometrial cancer.Patients and methods: A total of 205 patients with 102 cases of endometrial atypical hyperplasia and 103 cases of endometrial carcinoma treated by the Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from January 1, 2010, to December 31, 2015 were collected as the study group. And 205 patients with simple endometrial hyperplasia or polyp hyperplasia in the same period were selected as the control group using age-matched method. Laboratory results of metabolic factors such as blood pressure (BP), glucose (GLU), triglycerides (TC), and high-density lipoprotein (HDL) were retrieved from the clinical data of two groups of patients. Multivariable logistic regression analysis was used to determine the risk factors associated with endometrial malignant hyperplasia and to develop a nomogram prediction model of risk factors associated with endometrial malignant hyperplasia. Discrimination, calibration, and clinical usefulness of the predicting model were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was assessed using the bootstrapping validation.Results: Predictors included in the Nomogram prediction model included hypertension, diabetes, BMI, uric acid, hyperlipidemia and CA199. The model had a C-index of 0.782 (95% confidence interval 0.738-0.826) with good discrimination and good calibration. A high C-index value of 0.771 could still be reached in the interval validation. Decision curve analysis showed that it is meaningful to use this Nomogram for patient interventions when the threshold probability is within 22-86%.Conclusion: The development of endometrial malignant hyperplasia is significantly associated with metabolic factors. BMI>25, hyperuricemia, and hyperlipidemia are the main risk factors for the development of endometrial malignant hyperplasia. Hypertension, hyperglycemia and elevated CA199 were also associated with the development of endometrial malignant hyperplasia in our study. The Nomogram prediction model based on physical examination and laboratory testing developed in this study can be used as a rapid method for predicting the risk of endometrial malignancy development and screening for risk factors in a population of women with metabolism-related high-risk factors.
Risk factors for endometrial cancer: An umbrella review of the literature