Development and Validation of a Nomogram to Predict the Risk of Special Uterine Leiomyoma Pathological Types or Leiomyosarcoma in Postmenopausal Women: A Retrospective Study

Figures & data

Figure 1 Flow chart of this study.

Table 1 Baseline Characteristics of the Enrolled Participants

Variables	Patients with Pathology Suggestive Only of UL (n=652)	Patients with Pathology Suggestive of Special Uterine Leiomyoma Pathological types or Leiomyosarcoma (n=55)	test	P
Menopausal time≥10 years (n(%))	251 (38.5%)	23 (41.8%)	p
Have clinical symptoms related to UL (n(%))	179 (27.5%)	13 (23.6%)	p
The discovery time of UL after menopause after menopause (n(%))	423 (64.9%)	33 (60.0%)	p
The changing trend of UL after menopause (n(%))			p	*
Discreased or stable	313 (48.0%)	16 (29.1%)
Increased	217 (33.3%)	25 (45.5%)
Unknown	122 (18.7%)	14 (25.5%)
Have a history of hysteromyoma related surgery	20 (3.1%)	0(0.0%)	p
Age of menarche (Mean (95% CI))	15.22 (15.09–15.35)	14.76 (14.37–15.15)	u
Gravidity (n(%))			p
0	5 (0.8%)	1 (1.8%)
1	67 (10.3%)	4 (7.3%)
2	207 (31.7%)	30 (54.5%)
3	216 (33.1%)	13 (23.6%)
4	95 (14.6%)	3 (5.5%)
5	42 (6.4%)	4 (7.3%)
6	12 (1.8%)	0 (0.0%)
7	6(0.9%)	0 (0.0%)
8	2(0.3%)	0 (0.0%)
Parity (n(%))			p
0	9 (1.4%)	2 (3.6%)
1	375 (57.5%)	30 (54.5%)
2	194 (29.8%)	19 (34.5%)
3	58 (8.9%)	2 (3.6%)
4	12 (1.8%)	2 (3.6%)
5	3 (0.5%)	0 (0.0%)
8	1 (0.2%)	0 (0.0%)
Have a confirmed hypertension disease (n(%))	235 (36.0%)	27 (49.1%)	p
Have a confirmed diabetes disease (n(%))	59 (9.0%)	6 (10.9%)	p
Have a confirmed thyroid diseases (n(%))	40 (6.1%)	3 (5.5%)	p
Have a confirmed breast cancer disease (n(%))	24 (3.7%)	1 (1.8%)	p
Have a history of tamoxifen use (n(%))	8 (1.2%)	0 (0.0%)	p
Number of UL indicated by B-ultrasound > =2 (n(%))	361 (55.4%)	34 (61.8%)	p
The diameter of the largest UL indicated by B-ultrasound ≥5cm(n(%))	250 (38.3%)	36 (65.5%)	p	***
Estradiol hormone (E2) (n(%))			p
<100pmol/L	631 (96.8%)	51 (92.7%)
100–300pmol/L	14 (2.1%)	3 (5.5%)
>300pmol/L	7 (1.1%)	1 (1.8%)
Progestational hormone value ≥ 2.2nmol/L(n(%))	9 (1.4%)	2 (3.6%)	p
Testosterone value ≥1.2nmol/L (n(%))	36 (5.5%)	5 (9.1%)	p
Body mass index(BMI) (Mean(95% CI))	23.79 (23.52–24.04)	24.58 (23.60–25.54)	u
Rate of absolute value of platelet and lymphocyte (PLR) (Mean(95% CI))	137.59 (134.07–141.12)	137.25 (124.870149.64)	u
Rate of absolute value of neutrophil and lymphocyte(NLR) (Mean(95% CI))	2.34 (2.24–2.43)	2.59 (2.27–2.91)	u
Carcinoembryonic antigen 125 (CA125) (Mean(95% CI))	12.15 (11.59–12.71)	14.36 (11.48–17.24)	u
Thyroid stimulating hormoneat value(TSH) (Mean(95% CI))	1.74 (1.66–1.83)	1.71 (1.41–2.01)	u
Lactic dehydrogenase value(LDH) (Mean(95% CI))	188.65 (186.17–191.13)	194.13 (180.38–207.88)	u
Triglyceride value(TC) (Mean(95% CI))	1.89 (1.79–1.99)	2.1 (1.73–2.47)	u
Total cholesterol index(TG) (Mean(95% CI))	5.3 (5.23–5.38)	5.41 (5.07–5.74)	u
Calcium ion concentration(Ca) (Mean(95% CI))	2.33 (2.32–2.34)	2.31 (2.29–2.34)	u
Concentration of magnesium(Mg) (Mean(95% CI))	0.85 (0.85–0.86)	0.85 (0.83–0.87)	u
Phosphorus ion concentration(Ph) (Mean(95% CI))	1.34 (0.96–1.73)	1.11 (1.07–1.15)	u	*
Total ferritin value(TF) (Mean(95% CI))	14.77 (14.41–15.13)	14.16 (13.00–15.32)	u
Transferrin value(trf) (Mean(95% CI))	2.47 (2.44–2.50)	2.47 (2.40–2.54)	u
Homocysteine value(Hcy) (Mean(95% CI))	11.1 (10.80–11.40)	10.96 (10.08–11.84)	u

Notes: p: Chi square test, u: Mann–Whitney test; *P ≤ 0.05, ***P ≤ 0.001.

Table 2 Association of UL with Selected Variables in Bivariate Analysis and in Multivariable Models

Characteristics	OR(uni)	Cl(uni)	P(uni)	OR(multi)	CI(multi)	P(multi)
Body mass index(BMI)	1.11	0.64–1.93	0.705
Have a confirmed breast cancer disease	0.48	0.06–3.65	0.482
Calcium ion concentration(Ca)	0.64	0.37–1.12	0.119
Carcinoembryonic antigen 125 (CA125)	1.97	1.12–3.47	0.019	1.67	0.94–2.98	0.084
Have clinical symptoms related to UL	0.82	0.43–1.56	0.542
Have a confirmed diabetes disease	1.23	0.51–3	0.647
Estradiol hormone (E2)	1.67	0.76–3.65	0.2
The discovery time of UL after menopause after menopause	0.81	0.46–1.43	0.469
Gravidity	0.46	0.2–1.04	0.061
Have a confirmed hypertension disease	1.71	0.98–2.97	0.057
Homocysteine value(Hcy)	1.75	0.97–3.16	0.065
Lactic dehydrogenase value(LDH)	0.97	0.7–1.35	0.87
Menopause.period 10	1.15	0.66–2.01	0.628
Age of menarche	0.77	0.43–1.37	0.365
Concentration of magnesium(Mg)	1.01	0.67–1.53	0.946
Rate of absolute value of neutrophil and lymphocyte(NLR)	2.32	1.25–4.31	0.008	2.14	1.11–4.11	0.022
Number of UL indicated by B-ultrasound > =2	1.31	0.74–2.3	0.356
Progesterone at value ≥ 2.2nmol/	2.7	0.57–12.81	0.212
Parity	0.61	0.22–1.74	0.359
Phosphorus ion concentration(Ph)	0.5	0.27–0.96	0.037	0.52	0.27–1	0.051
Rate of absolute value of platelet and lymphocyte (PLR)	1.1	0.76–1.6	0.618
Have a history of hysteromyoma related surgery	0	0-Inf	0.986
The diameter of the largest UL indicated by B-ultrasound ≥5cm	3.05	1.71–5.43	<0.001	2.94	1.62–5.33	<0.001
Have a history of tamoxifen use	0	0-Inf	0.987
Triglyceride value(TC)	1.52	0.87–2.64	0.14
Total ferritin value(TF)	0.84	0.48–1.46	0.535
Total cholesterol index(TG)	1.02	0.59–1.76	0.951
Have a confirmed thyroid diseases	0.88	0.26–2.95	0.839
The changing trend of UL after menopause	1.52	1.07–2.16	0.018	1.4	0.94–2.07	0.094
Transferrin value(trf)	1.35	0.78–2.35	0.285
Thyroid stimulating hormoneat value(TSH)	1.67	0.51–5.46	0.395
Testosterone value ≥1.2nmol/L	1.71	0.64–4.55	0.282

Figure 2 Nomogram prediction of UL for special pathological types or leiomyosarcoma in postmenopausal women trend: the increasing trend after menopause, size: the diameter of the largest uterine fibroid, CA125: serum carcinoembryonic antigen 125 concentration, NLR: Serum neutrophil to lymphocyte ratio, Ph: Serum phosphorus ion concentration.

Figure 3 Receiver operating characteristic curve.

Abbreviation: AUC, Area under the receiver operating characteristic curve.

Figure 4 Calibration plot for predicted probability of special uterine leiomyoma pathological types or leiomyosarcoma. When the solid black line (Logistic calibration) was closer to the grey line (ideal model), the prediction accuracy of the nomogram was better.

Figure 5 DCA for the prediction model. Red solid line: Prediction model; the gray line: Assume all postmenopausal patients have special uterine leiomyoma pathological types or leiomyosarcoma. Solid horizontal line: Assume no postmenopausal patients have special uterine leiomyoma pathological types or leiomyosarcoma. The graph indicates the expected net benefit per patient relative to the nomogram prediction of special uterine leiomyoma pathological types or leiomyosarcoma; model new: new 5 factor model.

Figure 6 Comparison chart of AUC curve between our 5 factors model and clinical experience model. Black solid line: the AUC of new 5 factor model; Red solid line: the AUC of clinical experience model; model new: new 5 factor (changing trend after menopause, the diameter of the largest UL indicated by B-ultrasound, CA125, NLR, and Serum phosphorus ion concentration) model; model clinical: clinical experience (clinical symptoms related to UL, changing trend of UL after menopause, and diameter of the largest UL indicated by B-ultrasound) model.

Figure 7 DCA between our 5-factor model (model new) and clinical-experience model (model clinical). Blue solid line: the DCA of new 5 factor model; Red solid line: the DCA of clinical model; model new: new 5 factor (changing trend after menopause, the diameter of the largest UL indicated by B-ultrasound, CA125, NLR, and Serum phosphorus ion concentration) model; model clinical: clinical experience (clinical symptoms related to UL, changing trend of UL after menopause, and diameter of the largest UL indicated by B-ultrasound) model.

Data Sharing Statement

The data used for analysis is fully available in the manuscript file without restriction.