A prognostic nomogram for overall survival after neoadjuvant radiotherapy or chemoradiotherapy in thoracic esophageal squamous cell carcinoma: a retrospective analysis
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Wei Deng1, Qifeng Wang2, Zefen Xiao1, Lijun Tan3, Zhao Yang4, Zongmei Zhou1, Hongxing Zhang1, Dongfu Chen1, Qinfu Feng1, Jun Liang1, Yexiong Li1, Jie He5, Shugeng Gao5, Kelin Sun5, Guiyu Cheng5, Xiangyang Liu5, Dekang Fang5, Qi Xue5, Yousheng Mao5, Dali Wang5 and Jian Li5
1Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
2Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu, China
3Department of Oncology, First Hospital of Harbin Medical College, Harbin, China
4Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
5Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Zefen Xiao, email: firstname.lastname@example.org
Keywords: esophageal carcinoma, nomogram, neoadjuvant therapy, overall survival, recursive partitioning analysis
Received: October 27, 2016 Accepted: March 22, 2017 Published: April 12, 2017
Background: Currently, the AJCC staging system or pathological complete response (pCR) are considered not sufficiently accurate to evaluate the survival of patients with esophageal squamous cell carcinoma after neoadjuvant radiotherapy or chemoradiotherapy. This study aimed to establish a nomogram and a recursive partitioning analysis (RPA) model to estimate prognosis and to provide advice for subsequent treatments.
Methods: We analyzed retrospectively 407 patients that were diagnosed with thoracic esophageal squamous cell carcinoma (TESCC) and received neoadjuvant radiotherapy or chemoradiotherapy. Hazard ratios and 95% confidence intervals of categorical clinicopathological characteristics with overall survival (OS) were calculated using the Cox proportional hazard model. The nomogram and RPA model were then established and total scores according to each variable were calculated and stratified to predict OS.
Results: Patients were followed-up over a median 49.9 months. AJCC did not perform well in distinguishing OS among each stage except for IIB and IIIA. Patients were divided into 4 groups according to the total scores based on nomogram (low risk: ≤180; intermediate risk: 180-270; high risk: 270-340; very high risk: >340). The 5-year OS was 57.3%, 40.7%, 18.3%, 6.1% respectively (p<0.05). RPA model also divide the patients into 4 groups, though group2 and group3 were not statistically significant (p=0.574).
Conclusion: The nomogram is a good evaluation model for estimating the prognosis of patients with TESCC after neoadjuvant radiotherapy or chemoradiotherapy compared with the AJCC and RPA. The results of this study also suggested that the high-risk subgroups need further treatments.
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