Development and validation of nomograms to predict overall survival and cancer specific survival of patients with primary fallopian tube carcinoma

doi:10.21203/rs.3.rs-2439593/v1

Download PDF

Research Article

Development and validation of nomograms to predict overall survival and cancer specific survival of patients with primary fallopian tube carcinoma

https://doi.org/10.21203/rs.3.rs-2439593/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

Primary fallopian tube carcinoma (PFTC) is a rare neoplasm. The purpose of this study is to identify which factors and markers contribute to affect the clinical prognosis of patients with PFTC, and to inform treatment and preventive strategies.

Methods

Patients were selected from those with confirmed PFTC registered in 2010 till 2015 from the Surveillance, Epidemiology and End Results (SEER) database. Independent prognostic factors were identified using univariate and multivariate Cox proportional hazard regression models. These factors were used to construct a nomogram model, a survival prognostication tool for3-and 5-year overall survival (OS) and tumor-specific survival (CSS) among patients with PFTC. Kaplan-Meier curves and log-rank tests were used to assess differences in survival time between groups.

Results

A total of 1241 patients were randomly assigned to the training group (n = 869) and the test group (n = 372). Kaplan-Meier survival analysis showed a similar 3-year/5-year OS and CSS in patients with PFTC (70.1%/55.4% and 71.7%/57.2%, respectively). In multivariate Cox regression analysis, age (22–56, 57–71 and 72–92), race (white, black and other), International Federation of Gynecology and Obstetrics (FIGO) staging (I, II, III, and IV) and laterality (lateral and bilateral) were independent prognostic factors for patients with PFTC. Finally, a nomogram consisting of age, race, FIGO stage, type of surgery and lymphadenectomy were constructed. The area under the time-dependent receiver operating characteristic (ROC) curve values of 3-/5-year OS were 0.730/0.750 in the training group and 0.726/0.803 in the test group.

Conclusions

Nomograms constructed using various clinical indicators could help identify patients with high-risk PFTC. We have identified prognostic factors associated with OS and CSS. These factors can be examined and included further in large clinical trials involving this rare carcinoma.

Primary fallopian tube carcinoma (PFTC)

overall survival

cancer-specific survival

nomogram

prognostic factors

Primary fallopian tube carcinoma (PFTC) is an rare gynaecological tumor, accounting for 0.14–1.8% of malignancies of the reproductive system ¹. However, given recent evidence that ovarian and other pelvic cancers may originate in the fallopian tubes, the actual incidence of PFTC may be underestimated ^{2, 3}. A study analyzing the data of United States Cancer Statistics from 2001 to 2005, 2006– 2010, and 2011–2014, showed an increase in PFTC from 0.19 to 0.35 to 0.63 (per 100,000 women) ⁴. The increase in clinical diagnosis of PFTC may further reflect the growing evidence that the fallopian tubes are the major source of extrauterine pelvic plasmacytoma ^4–6.

However, the low incidence of PFTC means individual institutions can only generate very limited data. Available data describing PFTC are usually derived from small case reports or series, including a limited number of patients on long time treatment ⁷. It is difficult to draw credible conclusions about survival and prognosis of PFTC due to the lack of sufficient evidence ⁸. Although most studies agreed that the International Federation of Gynecology and Obstetrics (FIGO) staging is the most effective predictor, the impact of race, histology, histological grading and laterality on prognosis of PFTC remains controversial. In addition, no studies have evaluated the predictive performance of new FIGO staging system (8th ed, 2017) on overall survival (OS) and cancer specific survival (CSS) in patients with PFTC.

The Surveillance, Epidemiology, and End Results (SEER) database of interest is a large population-based cancer registry covering approximately 34.6% of the United States (US) population. Widely distributed patient data from 17 regions of the United States to minimize potential selection bias ⁹. In this article, we evaluated patients with PFTC diagnosed between 2010 and 2015 in the SEER database. Our aim was to develop and validate prognostic nomograms of OS and CSS, and to indentify factors and markers that affect the clinical prognosis of patients with PFTC. These prognostic factors may be clinically important for inclusion in large clinical trials and further study in the future.

Patient Selection

Patients with PFTC between 2010 and 2015 were extracted from the SEER database using SEER^*Stat software (version 8.3.8). Inclusion criteria were as follows: (1) primary site labeled ‘C57.0-Fallopian tube’; (2) first primary tumor confirmed by pathological biopsy; and (3) active follow-up. Exclusion criteria were as follows: (1) lack of information on race, marital status, histology, histological grade, laterality, American Joint Committee on Cancer (AJCC) TNM staging system, lymph node metastasis, type of surgery, lymphadenectomy, or chemotherapy; (2) unknown cause of death; (3) patients died within 1 month or less than 1 month of follow-up.

Patient Enrollment And Variable Recode

Patients diagnosed between 2010 and 2015 were randomly assigned to the training and testing cohorts in a 7:3 ratio. The training group was used to screen for variables and constructed a prognostic nomogram. The test group was used to validate the statistical results.

Data collected from the SEER database included age, marital status, race, histology, histological grade, FIGO staging, laterality, lymph node metastasis, type of surgery, lymphadenectomy and chemotherapy. The types of urgery included (1) no resection, (2) partial surgical resection, (3) total surgical resection, (4) surgery known as ‘debulking’, and (5) radical surgery resection (resection of the primary site with removal of other organs). The FIGO staging system is based on AJCC cancer staging system (8th edition) (10): (1) Stage Ⅰ:T1a/1b/1c-N0-M0, (2) Stage Ⅱ: T2a/2b-N0-M0, (3) Stage Ⅲ: T1/T2-N1-M0 or T3a/3b/3c-NX/N0/N1-M0, (4) Stage Ⅳ: TX-NX-M1.

Statistical Analysis

Optimal cut-off values were defined using X-tile software (Yale University). A chi-square test with P < 0.05 was considered a statistically significant difference between groups. Independent prognostic factors for PFTC were screened using univariate and multivariate Cox regression analysis. Variables with P < 0.1 in univariate Cox regression were selected into multivariate Cox regression and variables with P < 0.05 in multivariate Cox regression were defined as independent prognostic factor. Cox regression analysis with 95% confidence interval (CI), hazard ratios (HR) and chi-square test were performed using SPSS (version 22.0).

Nomograms were drawn using R softwar (version 4.0.3) based on clinical and statistical significance of multifactorial analysis. OS and CSS were the endpoints of this study, calculated from diagnosis to death or to the last follow-up date in November 2018. OS and CSS at 3 and 5 years were estimated by prognostic nomograms. The nomogram was validated internally and externally. Discriminative power was assessed using the area under the time-dependent receiver operating characteristic curve (AUC). In general, AUC values greater than 0.7 indicate ideal estimates. A calibration plot was used to evaluate the calibration ability of the nomogram. Decision curve analysis (DCA) was used to compare with the FIGO staging system to evaluate the clinical efficacy and usefulness of nomogram. Kaplan-Meier curves and log-rank test were used to analyze survival differences of each variable.

Clinical Characteristics of Patients

A total of 1241 patients with PFTC were randomly divided into a training group (n = 869) and a testing group (n = 372). The clinical characteristics of the patients are presented in Table 1. There was no significant difference in the number of training, testing, and total groups(P > 0.05). Patients aged 22–56, 57–71 and 72–92 years were 302 (24.3%), 662 (50.1%), and 317 (25.5%), respectively. There were 1050 (84.6%) white people, 75 (6.0%) black people, and 116 (9.3%) people of other races. There were 188 (15.1%) single, 725 (58.4%) married, 156 (12.6%) divorced or separated and 172 (13.9) widowed. There were 1005 (81.0%) and 236 (19.0%) cases of plasmacytoma and non-plasmacytoma, respectively. Histological grading was 28 cases for grade I (2.3%), 70 cases for grade II (5.6%), 575 cases for grade III (46.3%) and 568 cases for grade IV (45.8%). Patients with FIGO staging I, II, III, and IV were 193 (15.6%), 191 (15.4%), 661 (53.3%) and 196 (15.8%), respectively. The number of patients with left, right and bilateral laterality was 506 (40.8%), 580 (46.7%) and 155 (12.5%), respectively. The numbers of those with and without lymph node metastasis were 922 (74.3%) and 319 (25.7%); those without lymphadenectomy and with 1–3 or 4 or more lymph nodes dissection were 526 (42.4%), 154 (12.4%) and 561 (45.2%), respectively. The numbers of people without surgery and with partial, total, debulking or radical surgery were 4(0.3%), 39 (3.1%), 258 (20.8%), 455 (36.7%) and 485 (39.1%), respectively. The numbers of those with and without chemotherapy were 206 (16.6%) and 1035 (83.4%), respectively. In the univariate Cox regression analysis of OS and CSS, the integral P-value for all variables except histology and chemotherapy was < 0.1 (Table 2). In multivariate Cox regression analysis for OS, age (22–56, 57–71 and presented), race (white, black and other), FIGO staging (I, II, III, and IV) and laterality (lateral and bilateral) were statistically significant (P < 0.05) and were identified as independent prognostic factors (Table 3).

Development And Validation Of Nomograms

Based on the positive stepwise (Likelihood Ratio) results of multivariate Cox regression, models that included age, race and FIGO staging had the smallest − 2 Log Likelihood values in the training cohort. However, it is crucial to consider and discuss clinical and statistical significance when screening variables for inclusion ¹⁰. Therefore, we included the type of surgery and lymph node dissection in the prediction model, as they were the main treatments associated with prognosis of PFTC patients in the clinic. As shown in the nomogram (Fig. 1), each variable has a corresponding nomogram score listed in Supplementary Table 1. Total patient scores corresponding to 3-year and 5-year OS and CSS were calculated using the nomogram. The AUC values of 3-/5-year OS were 0.730/0.750 for the training cohort and 0.726/0.803 for the test cohort, and the AUC values of 3-/5-year CSS were 0.725/0.748 for the training cohort and 0.732/0.799 for the test cohort (Fig. 2), indicating that the nomogram discrimination was ideal. In addition, the calibration curves of the two nomograms showed good agreement in their predicted values (Fig. 3). In conclusion, the survival nomogram for predicting PFTC patients has a strong discrimination and correction ability. More importantly, the DCA curves showed that both nomograms added a higher net benefit than the FIGO staging system (Fig. 4).

Due to the low incidence of PFTC, few studies on OS and CSS have been published. To our knowledge, this is the first prognostic nomogram prognostic chart to predict 3-year and 5-year OS and CSS in patients with PFTC. More importantly, the identification of prognostic variables can help clinicians to select the best treatment option. Our study showed that age (22–56, 57–71 and 72–92), race (white, balck and other), FIGO staging (I, II, III, and IV) and laterality (lateral and bilateral) were independent prognostic factors of OS and CSS in patients with PFTC. In published nomograms, the choice of variables usually depends on clinical evidence and data availability rather than statistical significance ¹⁰. The predictive models for OS and CSS included age, race, FIGO stage, type of surgery, and lymph node dissection according to the stepwise positive results and clinical significance of multivariate Cox regression. FIGO staging, type of surgery, and age were the three most important prognostic factors, as measured by the standard deviation of the Noto scale, followed by race and lymph node dissection (Fig. 1). It is consistent with most previous studies that the most significant prognostic factors for PFTC are FIGO staging and size of postoperative residual lesions ^{1, 11–17}.

Kaplan-Meier analysis showed similar OS and CSS at 3-year/5-year for PFTC (70.1%/55.4% and 71.7%/57.2%, respectively). In this study, 369/396 (93.2%) patients died from PFTC, suggesting that elimination of cancer is the top priority in treating patients with PFTC. As in most studies, our study shows that FIGO stage was the most relevant prognostic factor for prognosis. The 3-year/5-year OS for PFTC stage I, II, III and IV was 95.5%/90.4%, 85.9%/77.2%, 64.2%/44.3% and 51.9%/35.2%, respectively. The 3-year/5-year CSS for PFTC patients of stage I, II, III and IV were 96.4%/91.1%, 85.9%/77.2%, 66.0%/46.6% and 54.6%/37.0%, respectively. The OS and CSS were significantly lower in late PFTC (III and IV) than in early PFTC (I and II) (P < 0.001) (Fig. 5A). After correcting for the remaining confounders, the HR was 7.104 (95% CI, 3.340–15.110) and 8.87 (95% CI, 4.056–19.409) for stages III and IV compared with stage I, respectively (Table 3). A retrospective analysis of 1576 patients with PFTC diagnosed from 1988–2004 showed that the 5-year OS was 81%, 65%, 54% and 36% for stages I, II, III and IV, respectively ⁷. OS increased in patients with early stage PFTC and decreased in patients with late stage PFTC. How to improve survival of patients with advanced PFTC remains a challenge to be overcome.

Many studies have shown that optimal cytoreduction and minimal residual disease are important prognostic factors in advanced PFTC ^{11, 18}. It should be noted that optimal cytoreductive measures have changed in recent years to radical surgery ^19–21. Radical surgery includes extensive upper abdominal procedures such as diaphragmatic stripping and/or resection, partial hepatectomy, distal pancreatectomy, splenectomy, resection of tumor from the porta hepatis, and cholecystectomy ²². In our study, Kaplan-Meier analysis showed that patients with PFTC who underwent radical surgery had a significantly higher OS than those who underwent de-volumetric surgery (P < 0.05) (Fig. 5B). This may be due to fewer residual lesions after radical surgery. Peiretti et al. demonstrated that a more extensive surgical approach was associated with improved disease-free intervals and prolonged survival in patients with advanced PFTC ²⁰. However, it is also important to assess whether patienst can tolerate radical surgery, focus on quality of life and balance the oncologic benefits of surgery ^{23, 24}. Chi et al. found that incorporating extensive upper abdominal surgery into the surgical strategy significantly increaseed the rate of initial optimal cytopenia without significantly increasing perioperative morbidity and mortality^{22, 25}. These studies indicated that the principle of primary surgery is to leave as little macroscopic disease as possible in patients with PFTC ²⁰.

PFTC is thought to have a high propensity for lymph node metastasis secondary to its dense lymphatic supply ²⁶. Klein et al. found median survival time of 43 and 21 months for patients with and without lymph node dissection, respectively ²⁷. Kim et al. reported that lymphadenectomy increased OS and disease-free survival in patients with advanced PFTC ²⁰. In present studies, the reported lymph node positivity rate was 33 to 59% ^{1, 12, 26}. Only 25.3% of patients in this study had positive lymph nodes and 57.6% underwent lymph node dissection. Kaplan-Meier analysis showed that only resection of more than 3 lymph nodes significantly improved OS in patients with PFTC (P < 0.05) (Fig. 5C). In contrast, there was no statistically significant difference in multivariate Cox regression. Nevertheless, we recommended lymph node dissection because routine lymph node sampling and dissection is necessary for proper staging²⁷. In addition, Semrad et al. found that many patients with unclear initial lymph node status later relapsed, possibly because of the persistence of lymphatic disease ²⁸.

Stewart et al. found a similar distribution of left-sided disease (45.4%) and right-sided disease (42%) in a population-based study, with bilateral disease accounting for 7.7% of cases²⁹. In our study, we saw a similar distribution of left-sided disease (40.8%) and right-sided disease (46.7%), with bilateral involvement in 12.5% of cases. Fewer studies have performed on the prognostic impact of laterality on PFTC. A retrospective study of 36 patients with PFTC found that tumor laterality was a significant prognostic factor in predicting disease-free survival, while the diagnosis of left-sided disease significantly increased the risk of death (HR, 4.236; 95% CI, 1.37–13.10; P < 0.05) ¹³. However, our study showed no statistical difference between left and right involvement in predicting OS and CSS in patients with PFTC, while the diagnosis of bilateral disease significantly increased the risk of death (HR, 1.543; 95% CI, 1.084–2.195; P < 0.05) (Fig. 5D).

The prognostic significance of histology and histologic grading in PFTC remains controversial. Rosen et al., Cabrero et al. and Hellstrom et al. concluded that histologic grading was a significant prognostic factor, while histologic grading was not a significant prognostic factor in other studies ^{8, 16, 30–32}. Although most studies did not find prognostic significance of histology ^{1, 7, 12}, Riska et al. demonstrated a 5-year OS of 37% in patients with plasmacytoma and 17% in patients with non-plasmacytoma ¹⁴. In addition, Kietpeerakool et al. found in multivariate Cox regression that patients with plasmacytoma were 7.5 times more likely to experience recurrence than patients with non-plasmacytoma ³³. In our study, we did not find that histology and histologic grading were associated with survival in patients with PFTC.

In our study, the optimal age cut-off points were 56 and 71 years, which could better differentiate OS in patients with PFTC (Fig. 5E). The mean age at diagnosis in our study was 64 years, which is consistent with the previously reported 64 years^{16, 34}. In our study, age was an independent prognostic factor for OS and CSS in patients with PFTC. Mortality rates for women aged 57–71 and 72–92 years versus those aged 22–56 years were 1.525 (95% CI, 1.064–2.185) and 2.110 (95% CI, 1.416–3.144), respectively. Wethington et al. demonstrated that advanced age was an independent predictor of reduced survival in patients with PFTC, with a HR of 1.78 (95% CI, 1.51–2.11) for death in patients over 65 years of age. In addition, Gadducci et al. demonstrated that older age (> 58.5 years) was independently associated with poorer survival (HR, 2.3; 95% CI, 1.1–4.7) ¹².

To our knowledge, this is the first study to include race in the survival analysis and found that race was an independent prognostic factor for patients with PFTC. In this study, 84.6% of PFTC patients were white and 6% were black, which is similar to the results of Wethington’s study, in which 87% were white and 7% were black ⁷. Kaplan-Meier analysis showed that OS was significantly lower in white patients than in patients of other races (P < 0.05) (Fig. 5F). In multivariate Cox regression, the HR for death was 0.508 (95% CI, 0.266–0.972) and 0.598 (95% CI, 0.362–0.987) for black patients and patients of other races versus white patients, respectively. The impact of race on the prognosis of PFTC needs to be further investigated.

Although this study included a large number of patients, it still has some limitations. As a retrospective study, it is prone to information bias, and direct removal of missing data may increase bias. However, population-based data can be regarded as randomly distributed, reducing bias to some extent. In addition, we did not further analyze the prognostic impact of chemotherapy and recurrence due to the lack of information on chemotherapy regimens, recurrence, and cytoreductive status in the SEER database, and our use of different types of surgery to assess cytoreductive status may have been biased. Finally, the training cohort and test cohort data were obtained from the SEER database and lacked validation of other data. Nevertheless, the SEER registry covering approximately 34.6% of the US population is reasonablely representative. The widely distributed patient data from 17 US regions minimizes potential selection bias ⁹. In addition, our population-based study identified prognostic factors for patients with PFTC, providing a more effective treatment strategy for patients with PFTC.

In conclusion, our study suggests that age (22–56, 57–71 and 72–92), race (white, black and other), FIGO staging (I, II, III, and IV) and laterality (lateral and bilateral) are independent prognostic factors for PFTC that could be included in future clinical trials. This study constructed and validated prognostic nomograms 3- and 5-year OS and CSS in patients with PFTC, which may help gynecologists and general practitioners to better evaluate and treat patients with PFTC.

Acknowledgments

The authors acknowledge the data sharing and establishment of the Surveillance, Epidemiology, and End Results (SEER) database.

Competing interests

The authors declare no competing interests.

Data availability

Publicly available datasets from the Surveillance, Epidemiology, and End Results (SEER) database were analyzed in this study. This data can be found here: https://seer.cancer.gov/data/.

Ethics approval and consent to participate

Not applicable.

Declaration of personal and funding interests

NULL of the authors have any personal of funding interests.

Author contributions

The contribution of the individual authors is as follows: Ming Chen was involved in data collection, data analysis, and manuscript writing. Li Zeng was involved in data collection, analysis, and manuscript writing. Xiaozhu Liu, Pengcheng Hu, Mengnan Liu, Yuxue Zeng, Ling Liu, Xiguang Mao, and Chenyu Sun were involved in table and figure design. Muzi Meng, Scott Lowe, Chengliang Yin, Chenyu Sun and Xingyu Sun were involved in study design and manuscript editing. All the authors read and approved the final manuscript.

Pectasides D, Pectasides E, Economopoulos T. Fallopian tube carcinoma: a review. Oncologist. 11, 902-12 (2006).
Katabathina VS, et al. Extrauterine Pelvic Serous Carcinomas: Current Update on Pathology and Cross-sectional Imaging Findings. Radiographics. 36, 918-32 (2016).
Rezvani M, Shaaban AM. Fallopian tube disease in the nonpregnant patient. Radiographics. 31, 527-48 (2011).
Liao CI, et al. Trends in the incidence of serous fallopian tube, ovarian, and peritoneal cancer in the US. Gynecol Oncol. 149, 318-323 (2018).
Medeiros F, et al. The tubal fimbria is a preferred site for early adenocarcinoma in women with familial ovarian cancer syndrome. Am J Surg Pathol. 30, 230-6 (2006).
Shaw PA, Rouzbahman M, Pizer ES, Pintilie M, Begley H. Candidate serous cancer precursors in fallopian tube epithelium of BRCA1/2 mutation carriers. Mod Pathol. 22, 1133-8 (2009).
Wethington SL, et al. Improved survival for fallopian tube cancer: a comparison of clinical characteristics and outcome for primary fallopian tube and ovarian cancer. Cancer. 113, 3298-306 (2008).
Rosen AC, et al. A 15-year overview of management and prognosis in primary fallopian tube carcinoma. Austrian Cooperative Study Group for Fallopian Tube Carcinoma. Eur J Cancer. 34, 1725-9 (1998).
Usach I, et al. Survival differences in women with serous tubal, ovarian, peritoneal, and uterine carcinomas. Am J Obstet Gynecol. 212, 188.e1-6 (2015).
Iasonos A, Schrag D, Raj GV, Panageas KS. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol. 26, 1364-70 (2008).
Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 20, 1248-59 (2002).
Gadducci A, et al. Analysis of treatment failures and survival of patients with fallopian tube carcinoma: a cooperation task force (CTF) study. Gynecol Oncol. 81, 150-9 (2001).
Shamshirsaz AA, et al. A single-institution evaluation of factors important in fallopian tube carcinoma recurrence and survival. Int J Gynecol Cancer. 21, 1232-40 (2011).
Riska A, Leminen A. Updating on primary fallopian tube carcinoma. Acta Obstet Gynecol Scand. 86, 1419-26 (2007).
Horng HC, et al. Prognostic factors of primary fallopian tube cancer in a single institute in Taiwan. Int J Gynaecol Obstet. 127, 77-81 (2014).
Alvarado-Cabrero I, et al. Carcinoma of the fallopian tube: Results of a multi-institutional retrospective analysis of 127 patients with evaluation of staging and prognostic factors. Ann Diagn Pathol. 17, 159-64 (2013).
Pectasides D, et al. Primary fallopian tube carcinoma: results of a retrospective analysis of 64 patients. Gynecol Oncol. 115, 97-101 (2009).
Eisenkop SM, Friedman RL, Wang HJ. Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol. 69, 103-8 (1998).
Schnack TH, Sørensen RD, Nedergaard L, Høgdall C. Demographic clinical and prognostic characteristics of primary ovarian, peritoneal and tubal adenocarcinomas of serous histology--a prospective comparative study. Gynecol Oncol. 135, 278-84 (2014).
Peiretti M, et al. Role of maximal primary cytoreductive surgery in patients with advanced epithelial ovarian and tubal cancer: Surgical and oncological outcomes. Single institution experience. Gynecol Oncol. 119, 259-64 (2010).
Eisenhauer EL, et al. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer. Gynecol Oncol. 103, 1083-90 (2006).
Chi DS, et al. Improved optimal cytoreduction rates for stages IIIC and IV epithelial ovarian, fallopian tube, and primary peritoneal cancer: a change in surgical approach. Gynecol Oncol. 94, 650-4 (2004).
Martinez A, et al. Celiac lymph node resection and porta hepatis disease resection in advanced or recurrent epithelial ovarian, fallopian tube, and primary peritoneal cancer. Gynecol Oncol. 121, 258-63 (2011).
Cham S, et al. Development and validation of a risk-calculator for adverse perioperative outcomes for women with ovarian cancer. Am J Obstet Gynecol. 220, 571.e1-571.e8 (2019).
Chi DS, et al. The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas. Gynecol Oncol. 119, 38-42 (2010).
Moore KN, et al. Serous fallopian tube carcinoma: a retrospective, multi-institutional case-control comparison to serous adenocarcinoma of the ovary. Gynecol Oncol. 107, 398-403 (2007).
Klein M, Rosen AC, Lahousen M, Graf AH, Rainer A. Lymphadenectomy in primary carcinoma of the Fallopian tube. Cancer Lett. 147, 63-6 (1999).
Semrad N, et al. Fallopian tube adenocarcinoma: common extraperitoneal recurrence. Gynecol Oncol. 24, 230-5 (1986).
Stewart SL, Wike JM, Foster SL, Michaud F. The incidence of primary fallopian tube cancer in the United States. Gynecol Oncol. 107, 392-7 (2007).
Rosen AC, et al. A comparative analysis of management and prognosis in stage I and II fallopian tube carcinoma and epithelial ovarian cancer. Br J Cancer. 69, 577-9 (1994).
Hellström AC, Silfverswärd C, Nilsson B, Pettersson F. Carcinoma of the fallopian tube. A clinical and histopathologic review. The Radiumhemmet series. Int J Gynecol Cancer. 4, 395-400 (1994).
McMurray EH, et al. Carcinoma of the fallopian tube. Management and sites of failure. Cancer. 58, 2070-5 (1986).
Kietpeerakool C, et al. Survival and prognostic factors of patients with primary fallopian tube cancer receiving adjuvant paclitaxel and carboplatin chemotherapy. J Obstet Gynaecol Res. 40, 806-11 (2014).
Goodman MT, Shvetsov YB. Incidence of ovarian, peritoneal, and fallopian tube carcinomas in the United States, 1995-2004. Cancer Epidemiol Biomarkers Prev. 18, 132-9 (2009).

Tables 1-3 and Supplementary Table 1 are not available with this version

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Development and validation of nomograms to predict overall survival and cancer specific survival of patients with primary fallopian tube carcinoma

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

Introduction

Methods

Patient Selection

Patient Enrollment And Variable Recode

Statistical Analysis

Results

Clinical Characteristics of Patients

Development And Validation Of Nomograms

Discussion

Conclusion

Declarations

References

Tables and Supplementary Tables

Additional Declarations

Status:

Version 1