Nomogram and recursive partitioning analysis to predict overall survival in patients with stage IIB-III thoracic esophageal squamous cell carcinoma after esophagectomy

Abstract

We have developed statistical models for predicting survival in patients with stage IIB–III thoracic esophageal squamous cell carcinoma (ESCC) and assessing the efficacy of adjuvant treatment. From a retrospective review of 3,636 patients, we created a database of 1,004 patients with stage IIB–III thoracic ESCC who underwent esophagectomy with or without postoperative radiation. Using a multivariate Cox regression model, we assessed the prognostic impact of clinical and histological factors on overall survival (OS). Logistic analysis was performed to identify factors to include in a recursive partitioning analysis (RPA) to predict 5-year OS. The nomogram was evaluated internally based on the concordance index (C-index) and a calibration plot. The median survival time in the training dataset was 30.9 months, and the 5-year survival rate was 33.9%. T stage, differentiated grade, adjuvant treatment, tumor location, lymph node metastatic ratio (LNMR), and the presence of vascular carcinomatous thrombi were statistically significant predictors of 5-year OS. The C-index of the nomogram was 0.70 (95% CI 0.67–0.73). RPA resulted in a three-class stratification: class 1, LNMR ≤ 0.15 with adjuvant treatment; class 2, LNMR ≤ 0.15 without adjuvant treatment and LNMR > 0.15 with adjuvant treatment; and class 3, LNMR > 0.15 without adjuvant treatment. The three classes were statistically significant for OS (P < 0.001). Thus, the nomogram and RPA models predicted the prognosis of stage IIB–III ESCC patients and could be used in decision-making and clinical trials.

Integrated Bioinformatics Analysis Identifies Hub Genes Associated with the Pathogenesis and Prognosis of Esophageal Squamous Cell Carcinoma

“…Smoking, alcohol consumption, and their synergistic effects are the major risk factors for the development of ESCC [2,3], whereas obesity, gastroesophageal reflux disease, and Barrett's esophagus are the key risk factors for EAC [3]. e 5-year overall survival (OS) rate for patients with ESCC remains low at 10-20% [4]. Early diagnosis, and successful surgery, radiation therapy, and chemotherapy all contribute to a better prognosis for patients with EC.…”

Identification of key genes and pathways for esophageal squamous cell carcinoma by bioinformatics analysis

“…The primary histological type is esophageal squamous-cell carcinoma (ESCC), which accounts for ~90% of all EC cases in China. Patients with ESCC are usually diagnosed at an advanced stage, and their 5-year survival rate is therefore low (~10-20%) ( 3 , 4 ). It has been reported that smoking and alcohol consumption are major causative factors of ESCC, as they promote gene mutations associated with processes including tumor initiation, progression and even metastasis.…”

Perfil dos Pacientes com Câncer de Esôfago Diagnosticados entre 2001 e 2010 no Brasil

“…Com o intuito de aumentar a sobrevida e minimizar as complicações do tratamento, estratégias utilizando a radioterapia e a combinação de radioterapia à quimioterapia têm despertado o interesse da comunidade científica [10][11] . Entretanto, apesar do progresso nos últimos anos no tratamento do câncer de esôfago, a sobrevida dos pacientes, mesmo após ressecção completa, continua muito baixa, em razão do estádio avançado da doença ao diagnóstico [3][4][12][13][14] . Esse fato acontece, principalmente, por causa dos sinais do câncer só ocorrerem quando o tumor atingir volume suficiente para causar sintomas obstrutivos.…”