Analysis of prognostic factors and nomogram for predicting survival for patients with locally resectable esophageal cancer after preoperative chemoradiation therapy
Gao Bingyu1, Ma Mingwei2, Wang Huahong1, Xiong Hui3, Li Junxia1
1Department of Gastroenterology,Peking University First Hospital,Beijing 10034,China; 2Department of Radiation Oncology,Peking University First Hospital,Beijing 10034,China; 3Department of Emergency,Peking University First Hospital,Beijing 10034,China
Abstract：Objective The SEER database was utilized to analyze the prognosis and related factors for patients with locally resectable esophageal cancer undergoing preoperative chemoradiotherapy. A nomogram for predicting survival was established to provide reference for screening patients receiving preoperative chemoradiotherapy.Methods Patients diagnosed with stage T1b-4aN0-3M0(7thversion AJCC in 2010) resectable esophageal cancer receiving preoperative chemoradiotherapy between 2010 and 2015 were selected from the SEER database. The survival rate was determined by Kaplan-Meier method. The univariate analysis was performed by log-rank test. The multivariate analysis was conducted by Cox test. The nomogram for survival prediction was established by using R software. The predicting accuracy of the nomogram was evaluated by C-index and calibration curve.Results A total of 1 697 eligible patients were included. Univariate analysis showed that sex,T stage,N stage and tumor differentiation were significantly associated with overall survival (OS) and cancer-specific survival rate (CSS)(all P<0.001),and age (P=0.027) was significantly correlated with OS.Multivariate analysis demonstrated that age,sex,tumor differentiation and N stage were significantly associated with OS.Sex,tumor differentiation,T stage and N stage were significantly correlated with CSS (all P<0.05).After the prognostic factors were included into the nomogram,the C-index for 5-year OS and CSS was 0.60 and 0.61.The model for predicting survival of patients with esophageal squamous cell cancer was established by using the same method. The C-index for the OS and CSS was 0.62 and 0.64.Conclusions Sex,clinical stage and tumor differentiation are prognostic factors of CSS in patients with locally resectable esophageal cancer undergoing preoperative chemoradiotherapy followed by surgery. The nomogram established according to the data above can provide certain reference for the selection of preoperative chemoradiotherapy combined with surgery.
Gao Bingyu,Ma Mingwei,Wang Huahong et al. Analysis of prognostic factors and nomogram for predicting survival for patients with locally resectable esophageal cancer after preoperative chemoradiation therapy[J]. Chinese Journal of Radiation Oncology, 2019, 28(6): 412-416.
[1] Bedenne L,Michel P,Bouche O,et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus:FFCD 9102[J].J Clin Oncol,2007,25(10):1160-1168.DOI:10.1200/JCO.2005.04.7118. [2] Stahl M,Stuschke M,Lehmann N,et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus[J].J Clin Oncol,2005,23(10):2310-2317.DOI:10.1200/JCO.2005.00.034. [3] Herskovic A,Martz K,Faual-Sarraf M,et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus[J].N Engl J Med,1992,326(24):1593-1598.DOI:10.1056/nejm199206113262403. [4] Minsky BD,Pajak TF,Fau Ginsberg RJ,Ginsberg RJ,et al. INT 0123(Radiation Therapy Oncology Group 94-05) phase Ⅲ trial of combined-modality therapy for esophageal cancer:high-dose versus standard-dose radiation therapy[J].J Clin Oncol,2002,20(5):1167-1174.DOI:10.1200/jco.2002.20.5.1167. [5] Liu JF,Wang QZ,Hou J.Surgical treatment for cancer of the oesophagus and gastric cardia in Hebei,China[J].Br J Surg,2004,91(1):90-98.DOI:10.1002/bjs.4626. [6] van Hagen P,Mccmh JJ,van Lanschot B,et al. Preoperative chemoradiotherapy for esophageal or junctional cancer[J].N Engl J Med,2012,366(22):2074-2084.DOI:10.1056/NEJMoa1112088. [7] Lv J.Long-term efficacy of perioperative chemoradiotherapy on esophageal squamous cell carcinoma[J].World J Gastroenterol,2010,16(13):1649-1654.DOI:10.3748/wjg.v16.i13.1649. [8] Sjoquist KM,Burmeister BH,Smithers BM,et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma:an updated meta-analysis[J].Lancet Oncol,2011,12(7):681-692.DOI:10.1016/S1470-2045(11)70142-5. [9] 杨弘,傅剑华,刘孟忠,等.术前放化疗并手术治疗局部晚期食管鳞癌的多中心随机对照临床研究[J].中华医学杂志,2012,92(15):1028-1032.DOI:10.3760/cma.j.issn.0376-2491.2012.15.005. Yang H,Fu JH,Liu MZ,et al. A multi-centered randomized controlled study of neo-adjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of esophagus:an interim analysis[J].Chin J Med,2012,92(15):1028-1032.DOI:10.3760/cma.j.issn.0376-2491.2012.15.005. [10] 郑荣寿,孙可欣,张思维,等.2015中国恶性肿瘤流行情况分析[J].中华肿瘤杂志,2019,41(1):19-28.DOI:10.3760/cma.j.issn.0253-3766.2019.01.005. Zheng RS,Sun KX,Zhang SW,et al. Analysis of the prevalence of malignant tumors in China in 2015[J].Chin J Oncol,2019,41(1):19-28.DOI:10.3760/cma.j.issn.0253-3766.2019.01.005. [11] van Hagen P,Hulshof MC,van Lanschot JJ,et al. Preoperative chemoradiotherapy for esophageal or junctional cancer[J].New Engl J Med,2012,366(22):2074-2084.DOI:10.1056/NEJMoa1112088. [12] Yang Y,Zhang YJ,Zhu Y,Cao JZ,Yuan ZY,Xu LM,et al. Prognostic nomogram for overall survival in previously untreated patients with extranodal NK/T-cell lymphoma,nasal-type:a multicenter study[J].Leukemia,2015,29(7):1571-1577.DOI:10.1038/leu.2015.44. [13] 王玉祥,祝淑钗,邱嵘,等.三维适形<治疗T4期食管癌预后分析[J].肿瘤防治研究,2011(6):690-694.DOI:10.3971/j.issn.1000-8578.2011.06.023. Wang YX,Zhu SC,Qiu R,et al. Prognosis of T4 esophageal carcinoma with three-dimensional conformal radiotherapy[J].Cancer Res Prev Treat,2011(6):690-694.DOI:10.3971/j.issn.1000-8578.2011.06.023. [14] 普拉提·努尔别克,开丽曼·阿不都巴热,杨杰,等.三维适形调强治疗食管癌预后的影响因素分析[J].实用癌症杂志,2017,32(2):261-263.DOI:10.3969/j.issn.1001-5930.2017.02.026. Nurbik P,Abdubaje C,Yang J,et al. Analysis of factors influencing the prognosis of three-dimensional conformal radiother-apy and intensity modulated radiotherapy in the treatment of esophageal cancer[J].Part J Cancer,2017,32(2):261-263.DOI:10.3969/j.issn.1001-5930.2017.02.026. [15] Chan A,Wong A.Is combined chemotherapy and radiation therapy equally effective as surgical resection in localized esophageal carcinoma?[J].Int J Radiat Oncol Biol Phys,1999,45(2):265-270.DOI:10.1016/S0360-3016(99)00199-6. [16] Morgan MA,Lewis WG,Casbard A,et al. Stage-for-stage comparison of definitive chemoradiotherapy,surgery alone and neoadjuvant chemotherapy for oesophageal carcinoma[J].Br J Surg,2009,96(11):1300-1307.DOI:10.1002/bjs.7070. [17] Hongo M,Nagasaki Y,Shoji T.Epidemiology of esophageal cancer:Orient to Occident. Effects of chronology,geography and ethnicity[J].J Gastroenterol Hepatol,2009,24(5):729-735.DOI:10.1111/j.1440-1746.2009.05824.x. [18] Deng J,Chen H,Zhou D,et al. Comparative genomic analysis of esophageal squamous cell carcinoma between Asian and Caucasian patient populations[J].Nat Commun,2017,8(1):1533.DOI:10.1038/s41467-017-01730-x.
2019, Vol. 28 
