A modified survival model for patients with esophageal squamous cell carcinoma based on lymph nodes: A study based on SEER database and external validation

Abstract

BackgroundThe counts of examined lymph nodes (ELNs) in predicting the prognosis of patients with esophageal squamous cell carcinoma (ESCC) is a controversial issue. We conducted a retrospective study to develop an ELNs-based model to individualize ESCC prognosis.MethodsPatients with ESCC from the SEER database and our center were strictly screened. The optimal threshold value was determine by the X-tile software. A prognostic model for ESCC patients was developed and validated with R. The model’s efficacy was evaluated by C-index, ROC curve, and decision curve analysis (DCA).Results3,629 cases and 286 cases were screened from the SEER database and our center, respectively. The optimal cut-off value of ELNs was 10. Based on this, we constructed a model with a favorable C-index (training group: 0.708; external group 1: 0.687; external group 2: 0.652). The model performance evaluated with ROC curve is still reliable among the groups. 1-year AUC for nomogram in three groups (i.e., 0.753, 0.761, and 0.686) were superior to that of the TNM stage (P < 0.05). Similarly, the 3-year AUC and the 5-year AUC results for the model were also higher than that of the 8th TNM stage. By contrast, DCA showed the benefit of this model was better in the same follow-up period.ConclusionMore than 10 ELNs are helpful to evaluate the survival of ESCC patients. Based on this, an improved model for predicting the prognosis of ESCC patients was proposed.

Construction of a predictive model of abdominal lymph node metastasis in thoracic esophageal squamous cell carcinoma and preliminary analysis of its effect on target for postoperative radiotherapy

“…It was obvious that the shorter distance between the tumor and the abdomen was associated with the shorter distance of the tumor cells to invade the longitudinal lymphatic vessels in the esophageal wall, and the more likelihood of metastasis. Previous related studies have also shown that the location of lymph node metastasis in EC is closely related to the lesion location (18,19). Upper thoracic EC is mainly related to metastasis to the cervical and upper mediastinal lymph nodes, lower thoracic EC is mainly related to metastasis to the lower mediastinal and abdominal lymph nodes, and middle thoracic EC is related to metastasis to the neck, chest mediastinum, and abdominal lymph nodes.…”