Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg. 2018 Nov;106(5):1541-1547. doi: 10.1016/j.athoracsur.2018.05.055. Epub 2018 Jun 19.
Recently, a nomogram was developed for the prediction of overall survival (OS) after treatment with neoadjuvant chemoradiotherapy (nCRT) combined with surgery for esophageal or junctional cancer. The nomogram included clinical nodal category, pathologic tumor category, and number of positive lymph nodes in the resection specimen. The aim of this study was to externally validate the nomogram in an international multiinstitutional cohort of patients, and to explore the prognostic use of the nomogram for the prediction of progression-free survival (PFS) after nCRT plus surgery.
Patients with potentially resectable esophageal or junctional carcinoma that underwent nCRT plus surgery between 1998 and 2015 at 3 academic centers were included. The discriminative ability of the nomogram for the prediction of OS and PFS was quantified by Harrell's C-statistic. Calibration of the nomogram was visually assessed by plotting actual OS and PFS probabilities against predicted probabilities.
Some 975 patients were included. The discriminative ability of the nomogram for OS was moderate (C-statistic, 0.61) and comparable to that of the initial cohort (C-statistic, 0.63). The nomogram was also useful for the prediction of PFS (C-statistic, 0.64). Calibration of the nomogram was accurate for both OS and PFS, with predicted estimates corresponding closely with the actual observed estimates.
The nomogram accurately predicted OS and PFS after nCRT plus surgery in an independent international cohort of esophageal cancer patients. The current validated model may enable risk-stratified adjuvant treatment allocation and identify patients in need of routine surveillance after treatment.
最近，有人开发了一个列线图，用于预测接受新辅助放化疗（nCRT）联合手术治疗食管或交界性癌症后的总生存期（OS）。该列线图包括临床淋巴结分类、病理肿瘤分类和切除标本中阳性淋巴结的数量。本研究的目的是在国际多机构患者队列中对该列线图进行外部验证，并探讨该列线图在预测 nCRT 加手术后无进展生存期（PFS）中的预后作用。
纳入了 1998 年至 2015 年期间在 3 个学术中心接受 nCRT 联合手术治疗的潜在可切除食管或交界性癌患者。通过 Harrell 的 C 统计量来量化列线图对 OS 和 PFS 的预测能力。通过绘制实际 OS 和 PFS 概率与预测概率图来直观评估列线图的校准情况。
共纳入 975 例患者。该列线图对 OS 的判别能力中等（C 统计量为 0.61），与原始队列相当（C 统计量为 0.63）。该列线图也可用于预测 PFS（C 统计量为 0.64）。列线图对 OS 和 PFS 的校准均准确，预测估计与实际观察估计密切相关。
该列线图在独立的国际食管癌症患者队列中准确预测了 nCRT 加手术后的 OS 和 PFS。当前验证的模型可以实现风险分层辅助治疗分配，并识别治疗后需要常规监测的患者。
