AUTHOR=Wang Zizhuo , Song Kun , Liu Jingbo , Zhang Qing , Zhang Chuyao , Wang Beibei , Fu Yu , Wang Yu , Yao Shuzhong , Xu Congjian , Xia Min , Lou Ge , Liu Jihong , Lin Bei , Wang Jianliu , Zhao Weidong , Zhang Jieqing , Cheng Wenjun , Guo Hongyan , Guo Ruixia , Xue Fengxia , Wang Xipeng , Han Lili , Zhao Xia , Li Xiaomao , Zhang Ping , Zhao Jianguo , Ma Jiezhi , Yao Qin , Li Wenting , Yang Xiaohang , Fang Yong , Chen Gang , Li Kezhen , Shen Yuanming , Sun Chaoyang , Kong Beihua 

TITLE=Prognostic-Related Metabolic Score for Survival Prediction in Early-Stage Endometrioid Endometrial Cancer: A Multi-Center and Retrospective Study

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.830673

DOI=10.3389/fmed.2022.830673

ISSN=2296-858X

ABSTRACT=Objective: Endometrial cancer (EC) patients combined with metabolic syndrome (MetS) have a worse prognosis than those without MetS. This study aimed to investigate whether partial metabolic disorder also significantly influenced early-stage endometrioid EC (EEC) survival and hunted for a more efficient method to evaluate metabolic status.
Methods: This is a nationwide, multicenter cohort study including 998 primary early-stage EEC patients from 2001 to 2018. Patients were divided into different metabolic groups based on the diagnosis criteria of the Chinese Medical Association (CDC). The progression free survival time (PFS) was compared between various metabolic status. Meanwhile, we established an EC Prognostic Related Metabolic Score (ECPRM Score) to explore the association of the severity of metabolic status and early-stage EEC PFS. A nomogram for predicting PFS was established, which was externally validated in a testing set including 296 patients. 
Results: A partial metabolic disorder, as well as MetS, was an independent risk factor of poor survival of early-stage EEC patients (HR=7.6, 95% CI=1.01~57.5, P < 0.05). A high ECPRM Score was associated with more inferior PFS (HR=2.1, 95% CI=1.05~4.0, P < 0.001). The nomogram, in which the ECPRM Score contributed most to the prognosis, exhibited excellent discrimination of survival supported by the internal and external validation. Also, the calibration curve supports its robust predicting ability.
Conclusion: Even though they do not meet the criteria of MetS, partial metabolic disorders were also associated with adverse outcomes in early-stage EEC. ECPRM Score is beneficial for clinicians to evaluate the severity of metabolic abnormalities and guide patients to ameliorate the poor prognosis of metabolic disorders.