Development of a Risk Prediction Model for endometrial carcinoma among postmenopausal women in the Western province of Sri Lanka.

Abstract

Introduction: Globally, endometrial carcinoma is the most common reproductive tract cancer among women. Risk prediction model is a simple, low-cost tool to identify women with increased risk of developing endometrial carcinoma. Objectives: The aim of the study was to develop a model to predict the risk of endometrial carcinoma among postmenopausal women in Sri Lanka.

Methods: A case control study was conducted. The cases and the controls were defined as postmenopausal women who had and had not been diagnosed as endometrial carcinoma based on histological confirmation respectively. Variable selection was done considering the objectivity and feasibility of the measurements in addition to the statistical criteria. A scoring system [0-9] was designed based on weighted score of each risk predictor. Predictive validity of the model was tested by calibration and discrimination. Receiver Operator Characteristic (ROC) curve was used to determine the cut-off value.

Results: The developed model consisted of six predictors; Age >55 years, never conceived, age at menarche ≤11 years, ever experienced postmenopausal bleeding, having family history of any type of cancer among first degree relative, generalized obesity. Discrimination of the model was measured by the area under the ROC curve (0.92, 95% Confidence Interval: 0.88-0.95). Calibration with goodness of fit by Hosmer and Lemeshow test (p=0.72) was satisfactory. The tool demonstrated a good predictive ability with sensitivity of 79.5% (CI: 68.9%-87.3%) and specificity of 90.7% (CI: 86.8%-93.5%) at the cut-off point of 4.5.

Conclusions: Model demonstrated good discrimination and well calibration. It can be used in screening of high-risk women for developing endometrial carcinoma.