Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
J Natl Compr Canc Netw. 2016 Feb;14(2):173-9. doi: 10.6004/jnccn.2016.0020.
Among patients with localized esophageal cancer (LEC), 35% or more develop distant metastases (DM) as first relapse, most in the first 24 months after local therapy. Implementation of novel strategies may be possible if DM can be predicted reliably. We hypothesized that clinical variables could help generate a DM nomogram.
Patients with LEC who completed multimodality therapy were analyzed. Various statistical methods were used, including multivariate analysis to generate a nomogram. A concordance index (c-index) was established and validated using the bootstrap method.
Among 629 patients analyzed (356 trimodality/273 bimodality), 36% patients developed DM as first relapse. The median overall survival from DM was only 8.6 months (95% CI, 7.0-10.2). In a multivariate analysis, the variables associated with a higher risk for developing DM were poorly differentiated histology (hazard ratio [HR], 1.76; P<.0001), baseline T3/T4 primary (HR, 3.07; P=.0006), and baseline N+ LEC (HR, 2.01; P<.0001). Although variables associated with a lower risk for DM were age of 60 years or older (HR, 0.75; P=.04), squamous cell carcinoma (HR, 0.54; P=.013), and trimodality therapy (HR, 0.58; P=.0001), the bias-corrected c-index was 0.67 after 250 bootstrap resamples.
Our nomogram identified patients with LEC who developed DM with a high probability. The model needs to be refined (tumor and blood biomarkers) and validated. This type of model will allow implementation of novel strategies in patients with LEC.
在局限性食管癌（LEC）患者中，有 35%或更多的患者以远处转移（DM）作为首次复发，大多数发生在局部治疗后 24 个月内。如果能够可靠地预测 DM，就可能实施新的治疗策略。我们假设临床变量可以帮助生成 DM 列线图。
分析了完成多模式治疗的局限性食管癌患者。使用了各种统计方法，包括多变量分析来生成列线图。使用 bootstrap 方法建立和验证一致性指数（c-index）。
在分析的 629 例患者中（356 例三联治疗/273 例二联治疗），36%的患者以 DM 作为首次复发。从 DM 开始的中位总生存期仅为 8.6 个月（95%CI，7.0-10.2）。多变量分析显示，与 DM 发展风险较高相关的变量包括低分化组织学（HR，1.76；P<.0001）、基线 T3/T4 原发肿瘤（HR，3.07；P=.0006）和基线 N+LEC（HR，2.01；P<.0001）。尽管与 DM 发展风险较低相关的变量包括年龄 60 岁或以上（HR，0.75；P=.04）、鳞状细胞癌（HR，0.54；P=.013）和三联治疗（HR，0.58；P=.0001），但经过 250 次 bootstrap 重采样后，校正偏倚的 c-index 为 0.67。
我们的列线图确定了具有高 DM 发展概率的局限性食管癌患者。该模型需要进一步完善（肿瘤和血液生物标志物）并验证。这种类型的模型将允许在局限性食管癌患者中实施新的治疗策略。
