Nomograms Based on Fibrinogen, Albumin, Neutrophil-Lymphocyte Ratio, and Carbohydrate Antigen 125 for Predicting Endometrial Cancer Prognosis

SIMPLE SUMMARY: Endometrial cancer is a common gynecological malignancy, many patients have early clinical symptoms. However, disease progression and even death can occur in some cases after initial treatment. Identifying convenient and effective markers to predict the prognosis of patients with endometrial cancer and guide the selection of treatment options and patient management is urgently needed. In this study, the fibrinogen, albumin, NLR, and CA125 levels as well as other clinicopathological features of patients with endometrial cancer were recorded. Nomograms for predicting endometrial cancer prognosis created by combining fibrinogen, albumin, NLR, and CA125 levels were constructed, verified and evaluated, and the nomograms are highly accurate and have clinical application value, which provided a convenient method for predicting the prognosis of patients undergoing surgical treatment for endometrial cancer. ABSTRACT: Background: This study aimed to determine the prognostic value of the preoperative levels of fibrinogen, albumin (ALB), neutrophil–lymphocyte ratio (NLR), and carbohydrate antigen 125 (CA125) in endometrial cancer and to establish nomograms for predicting patient survival. Methods: Patients with endometrial cancer (n = 1483) who underwent surgery were included in this study, and their preoperative fibrinogen, ALB, NLR, and CA125 levels and clinicopathological characteristics were collected. Patients were randomized into a training cohort (70%, n = 1038) and an external validation cohort (30%, n = 445). The Cox regression analysis was performed using the data for the patients in the training cohort to identify independent prognostic factors; nomograms for predicting prognosis were established and validated. Results: High fibrinogen (≥3.185 g/L), NLR (≥2.521 g/L), and CA125 (≥35 U/mL) levels and low ALB (<4.185 g/L) levels were independently associated with poor progression-free survival (PFS) and poor overall survival (OS) in patients with endometrial cancer. Prognostic prediction model nomograms were developed and validated based on these results. Calibration curves and C-indexes underscored the good predictive power of the nomograms, and both the net reclassification index (NRI) and integrated discrimination improvement (IDI) values of the prognostic prediction model nomograms were improved. Conclusions: Nomograms that are developed based on preoperative fibrinogen, ALB, NLR, and CA125 levels accurately predict PFS and OS in patients with endometrial cancer.