Development of a clinical prediction model for pathological upgrade from endometrial atypical hyperplasia to endometrial cancer: a retrospective Eastern Chinese cohort study.

BACKGROUD: Endometrial cancer (EC), the most prevalent gynecologic malignancy in developed countries, often arises from endometrial atypical hyperplasia (EAH). Thus, how to predict EAH combined with EC before total hysterectomy is particularly important. OBJECTIVE: This study aimed to identify preoperative predictors of pathological upgrade from EAH to EC and develop a clinical prediction model. STUDY DESIGN: This retrospective cohort study analyzed 519 patients who underwent hysterectomy with EAH diagnosed on biopsy. Postoperative pathology classified patients into the EAH (n=413) or EC (n=106) group. Demographic, clinical, laboratory, and imaging data were compared. Multivariate logistic regression and ROC analyses identified risk factors and model performance. RESULTS: In this study, 20.42% (106/519) of cases with EAH were confirmed as EC after hysterectomy. The number of EC patients with stage Ia, Ib, II, and III were 91 (85.85%), 10 (9.43%), 1 (0.94%), and 4 (3.78%), respectively. Lymph node metastasis was observed in 2.83% (3/106) of the patients. The EC group exhibited significantly higher mean age (51.44 vs 49.63 years, P=.042), BMI (25.74 vs 24.80 kg/m2, P=.038), and endometrial thickness (1.05 vs 0.93 cm, P=.003). Metabolic markers [fasting glucose: 5.65 vs 5.30 mmol/L, P=.002; total cholesterol (TC): 5.34 vs 4.82 mmol/L, P<.0001] and coagulation indices (fibrinogen: 2.81 vs 2.44 g/L, P<.0001) were elevated in the EC group. Multivariate analysis identified six independent predictors: endometrial thickness (OR=2.894, P=.010), hemoglobin (OR=1.025, P=.020), human epididymis protein 4 (OR=1.023, P<.0001), TC (OR=1.607, P=.003), fibrinogen (OR=2.573, P=.001), and Lymphocyte-to-Monocyte Ratio (OR=1.210, P=.013). The six-factor combined model achieved an AUC of 0.794 (95% CI: 0.739-0.849), with 75.9% sensitivity and 73.0% specificity. Among the 255 patients (49.13%) who underwent preoperative magnetic resonance imaging (MRI) in our hospital, 49 were diagnosed with EAH and 54 with EC. The postoperative pathological concordance rates were 77.55% (38/49) for EAH and 77.78% (42/54) for EC. The combined model integrating MRI with hemoglobin, TC, and fibrinogen levels achieved an AUC of 0.871 (95% CI: 0.819-0.922), with a sensitivity of 69.6% and a specificity of 89.4%. The optimal cut-off values were >135.500 g/L for hemoglobin, >4.855 mmol/L for TC, and >2.910 g/L for fibrinogen. CONCLUSION: We established novel preoperative prediction models that integrates endometrial, metabolic, coagulation, inflammatory parameters, with the inclusion or exclusion of MRI features to identify co-existing endometrial carcinoma in atypical hyperplasia.