{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:52:14Z","timestamp":1753890734976,"version":"3.41.2"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T00:00:00Z","timestamp":1666742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This study aimed to develop a nomogram to predict the survival for stage IIIC endometrial cancer (EC) patients with adjuvant radiotherapy (ART) alone and personalize recommendations for the following adjuvant chemotherapy (ACT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In total, 746 stage IIIC EC patients with ART alone were selected from the Surveillance, Epidemiology, and End Results (SEER) registry. Cox regression analysis was performed to identify independent risk factors. A nomogram was developed accordingly, and the area under the receiver operating characteristic curve (AUC) and C-index were implemented to assess the predictive power. The patients were divided into different risk strata based on the total points derived from the nomogram, and survival probability was compared between each risk stratus and another SEER-based cohort of stage IIIC EC patients receiving ART+ACT (cohort ART+ACT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five independent predictors were included in the model, which had favorable discriminative power both in the training (C-index: 0.732; 95% CI: 0.704\u20130.760) and validation cohorts (C-index: 0.731; 95% CI: 0.709\u20130.753). The patients were divided into three risk strata (low risk &amp;lt;135, 135 \u2264 middle risk \u2264205, and high risk &amp;gt;205), where low-risk patients had survival advantages over patients from cohort ART+ACT (HR: 0.45, 95% CI: 0.33\u20130.61, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). However, the middle- and high-risk patients were inferior to patients from cohort ART+ACT in survival (<jats:italic>P<\/jats:italic> &amp;lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A nomogram was developed to exclusively predict the survival for stage IIIC EC patients with ART alone, based on which the low-risk patients might be perfect candidates to omit the following ACT. However, the middle- and high-risk patients would benefit from the following ACT.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2022.989063","type":"journal-article","created":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T06:54:20Z","timestamp":1666767260000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic model for the exemption of adjuvant chemotherapy in stage IIIC endometrial cancer patients"],"prefix":"10.3389","volume":"13","author":[{"given":"Xi-Lin","family":"Yang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng-Leng","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling-Na","family":"Kou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Da-Jun","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cong","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21708","article-title":"Cancer statistics, 2022","volume":"72","author":"Siegel","year":"2022","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181f39849","article-title":"Comparative performance of the 2009 international federation of gynecology and obstetrics' staging system for uterine corpus cancer","volume":"116","author":"Lewin","year":"2010","journal-title":"Obstet Gynecol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1006\/gyno.2001.6157","article-title":"Analysis of FIGO stage IIIc endometrial cancer patients","volume":"81","author":"McMeekin","year":"2001","journal-title":"Gynecol Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1006\/gyno.2002.6789","article-title":"Stage IIIC endometrioid corpus cancer includes distinct subgroups","volume":"87","author":"Mariani","year":"2002","journal-title":"Gynecol Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1997.313","article-title":"Treatment of node-positive endometrial cancer with complete node dissection, chemotherapy and radiation therapy","volume":"75","author":"Onda","year":"1997","journal-title":"Br J Cancer"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1006\/gyno.1999.5569","article-title":"FIGO stage IIIC endometrial carcinoma with metastases confined to pelvic lymph nodes: analysis of treatment outcomes, prognostic variables, and failure patterns following adjuvant radiation therapy","volume":"75","author":"Nelson","year":"1999","journal-title":"Gynecol Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30395-X","article-title":"Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): patterns of recurrence and post-hoc survival analysis of a randomised phase 3 trial","volume":"20","author":"de Boer","year":"2019","journal-title":"Lancet Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2019.05.002","article-title":"Adjuvant combined-modality therapy for stage IIIC endometrioid and non-endometrioid endometrial cancer","volume":"154","author":"Chapman","year":"2019","journal-title":"Gynecol Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2017.08.031","article-title":"Benefit of combination chemotherapy and radiation stratified by grade of stage IIIC endometrial cancer","volume":"147","author":"Binder","year":"2017","journal-title":"Gynecol Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2020.04.012","article-title":"Impact of different adjuvant treatment approaches on survival in stage III endometrial cancer: A population-based study","volume":"133","author":"van Weelden","year":"2020","journal-title":"Eur J Cancer"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics10060373","article-title":"Lymph node number predicts the efficacy of adjuvant chemoradiotherapy in node-positive endometrial cancer patients","volume":"10","author":"Lee","year":"2020","journal-title":"Diagn (Basel)"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29049","article-title":"The surveillance, epidemiology, and end results (SEER) program of the national cancer institute","author":"Cronin","year":"2014","journal-title":"Cancer"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.688535","article-title":"Comparison of different lymph node staging schemes for predicting survival outcomes in node-positive endometrioid endometrial cancer patients","volume":"8","author":"Yang","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2021.12.462","article-title":"Construction and validation of a prognostic model for stage IIIC endometrial cancer patients after surgery","volume":"48","author":"Yang","year":"2022","journal-title":"Eur J Surg Oncol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.ygyno.2011.02.040","article-title":"Endometrial cancer in the oldest old: Tumor characteristics, patterns of care, and outcome","volume":"122","author":"Wright","year":"2011","journal-title":"Gynecol Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.2217\/fon-2020-1308","article-title":"Impact of lymph node ratio in patients with stage IIIC endometrial carcinoma treated with postoperative radiotherapy","volume":"17","author":"Onal","year":"2021","journal-title":"Future Oncol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1136\/ijgc-2020-002158","article-title":"Sequencing chemotherapy before radiotherapy for women with stage IIIC endometrial cancer","volume":"31","author":"Narasimhulu","year":"2021","journal-title":"Int J Gynecol Cancer"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1136\/ijgc-2021-002450","article-title":"The impact of sentinel lymph node sampling versus traditional lymphadenectomy on the survival of patients with stage IIIC endometrial cancer","volume":"31","author":"Nasioudis","year":"2021","journal-title":"Int J Gynecol Cancer"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.811878","article-title":"Cancer-specific survival outcome in early-stage young breast cancer: Evidence from the SEER database analysis","volume":"12","author":"Liu","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2022.09.004","article-title":"A population-based risk scoring system to individualize adjuvant treatment for stage IIIC endometrial cancer patients after surgery","author":"Yang","year":"2022","journal-title":"Eur J Surg Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-020-09362-0","article-title":"Survival nomogram for stage IB non-Small-Cell lung cancer patients, based on the SEER database and an external validation cohort","volume":"28","author":"Zuo","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"m441","DOI":"10.1136\/bmj.m441","article-title":"Calculating the sample size required for developing a clinical prediction model","volume":"368","author":"Riley","year":"2020","journal-title":"BMJ"},{"volume-title":"NCCN clinical practice guidelines in oncology. uterine neoplasms version 1. 2022","year":"2021","key":"B23"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1813181","article-title":"Adjuvant chemotherapy plus radiation for locally advanced endometrial cancer","volume":"380","author":"Matei","year":"2019","journal-title":"N Engl J Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60442-5","article-title":"Contemporary management of endometrial cancer","volume":"379","author":"Wright","year":"2012","journal-title":"Lancet"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2017.09.015","article-title":"Primum non nocere: Are we ready for POLE testing in endometrial cancer","volume":"147","author":"Cosgrove","year":"2017","journal-title":"Gynecol Oncol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1038\/nature12113","article-title":"Integrated genomic characterization of endometrial carcinoma","volume":"497","year":"2013","journal-title":"Nature"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.01175","article-title":"Subdivision of IIIC stage for endometrioid carcinoma to better predict prognosis and treatment guidance","volume":"10","author":"Wen","year":"2020","journal-title":"Front Oncol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1758835920933036","DOI":"10.1177\/1758835920933036","article-title":"The characteristics of isolated para-aortic lymph node metastases in endometrial cancer and their prognostic significance","volume":"12","author":"Guo","year":"2020","journal-title":"Ther Adv Med Oncol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"538","DOI":"10.21037\/atm-20-5034","article-title":"Development and validation of predictive model for lymph node metastasis in endometrial cancer: a SEER analysis","volume":"9","author":"Li","year":"2021","journal-title":"Ann Transl Med"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygeno.2021.04.035","article-title":"A ten-gene methylation signature as a novel biomarker for improving prediction of prognosis and indicating gene targets in endometrial cancer","volume":"113","author":"Li","year":"2021","journal-title":"Genomics"},{"key":"B32","doi-asserted-by":"publisher","first-page":"6653247","DOI":"10.1155\/2021\/6653247","article-title":"A risk signature with nine stemness index-associated genes for predicting survival of patients with uterine corpus endometrial carcinoma","volume":"2021","author":"Xu","year":"2021","journal-title":"J Oncol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ygyno.2019.07.021","article-title":"Sequencing of therapy in women with stage III endometrial carcinoma receiving adjuvant combination chemotherapy and radiation","volume":"155","author":"Latham","year":"2019","journal-title":"Gynecol Oncol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.02.055","article-title":"A multi-institutional analysis of adjuvant chemotherapy and radiation sequence in women with stage IIIC endometrial cancer","volume":"110","author":"Hathout","year":"2021","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3802\/jgo.2019.30.e28","article-title":"A multi-institutional analysis of sequential versus 'sandwich' adjuvant chemotherapy and radiotherapy for stage IIIC endometrial carcinoma","volume":"30","author":"Onal","year":"2019","journal-title":"J Gynecol Oncol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1136\/ijgc-2020-001937","article-title":"Increased risk of recurrence in early-stage endometrial carcinoma after delays in adjuvant radiation treatment","volume":"31","author":"Zhu","year":"2021","journal-title":"Int J Gynecol Cancer"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-018-0310-8","article-title":"Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy","volume":"119","author":"Wortman","year":"2018","journal-title":"Br J Cancer"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2022.989063\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T06:54:25Z","timestamp":1666767265000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2022.989063\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,26]]},"references-count":37,"alternative-id":["10.3389\/fendo.2022.989063"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2022.989063","relation":{},"ISSN":["1664-2392"],"issn-type":[{"type":"electronic","value":"1664-2392"}],"subject":[],"published":{"date-parts":[[2022,10,26]]},"article-number":"989063"}}