Table 1_Preoperative risk stratification in endometrial carcinoma: a pragmatic, complementary nomogram using readily available clinical variables.docx

The ability of the nomogram to improve risk reclassification beyond conventional assessment was assessed with continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI).</p>Results<p>The nomogram achieved an AUC of 0.902 (95% CI: 0.857–0.948) in the training cohort, with an optimism-corrected AUC of 0.892 after 1,000 bootstrap resamples. In the validation cohort, the AUC was 0.866 (95% CI: 0.773–0.959), calibration was satisfactory (slope, 0.810; Brier score, 0.142; Hosmer–Lemeshow P = 0.156), and the nomogram demonstrated comparable or superior net benefit to conventional assessment across the majority of threshold probabilities, and showed improved risk reclassification (continuous NRI, 1.189, P = 0.019; IDI, 0.126, P = 0.013).</p>Conclusion<p>This nomogram, constructed from routinely available variables, demonstrated acceptable calibration in the validation cohort, despite a slight tendency toward risk underestimation.

While the incremental AUC over conventional assessment was not statistically significant, the model showed favorable net benefit on DCA and improved risk reclassification, suggesting it may serve as a useful adjunct for risk reclassification in specific clinical settings. Whether this translates into measurable improvements in surgical decision-making and patient outcomes awaits confirmation in prospective multicenter studies.</p>