School of Medicine, Shandong University, Jinan, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Ji Yan Road, Jinan, Shandong, 250012, People's Republic of China.
Radiat Oncol. 2019 Oct 22;14(1):181. doi: 10.1186/s13014-019-1385-y.
We aimed to identify the risk factors and provide a nomogram for the prediction of radiotherapy-related esophageal fistula in patients with esophageal cancer (EC) using a case-control study.
Patients with esophageal fistula who received radiotherapy or chemoradiotherapy between 2003 and 2017 were retrospectively collected in two institutions. In the training cohort (TC), clinical, pathologic, and serum data of 136 patients (cases) who developed esophageal fistula during or after radiotherapy were enrolled and compared with 272 controls (1:2 matched with the diagnosis time of EC, sex, marriage, and race). After the univariable and multivariable logistic regression analyses, the independent risk factors were identified and incorporated into a nomogram. Then the nomogram for the risk prediction was externally validated in the validation cohort (VC; 47 cases and 94 controls) using bootstrap resampling.
Multivariable analyses demonstrated that ECOG PS, BMI, T4, N2/3 and re-radiotherapy were independent factors for esophageal fistula. Then a nomogram was constructed with the C-index of 0.805 (95% CI, 0.762-0.848) for predicting the risk of developing esophageal fistula in EC patients receiving radiotherapy. Importantly, the C-index maintained 0.764 (95% CI, 0.683-0.845) after the external validation.
We created and externally validated the first risk nomogram of esophageal fistula associated with radiotherapy. This will aid individual risk stratification of patients with EC developing esophageal fistula.
本研究旨在通过病例对照研究，确定食管癌（EC）患者接受放疗后发生放射性食管瘘的危险因素，并建立预测模型。
回顾性收集 2003 年至 2017 年间在两家机构接受放疗或放化疗的食管瘘患者。在训练队列（TC）中，纳入了 136 例（病例）放疗或放化疗期间或之后发生食管瘘的患者的临床、病理和血清数据，并与 272 例（1:2 配对）EC 诊断时间、性别、婚姻状况和种族匹配的对照进行比较。在单变量和多变量逻辑回归分析后，确定独立的危险因素，并将其纳入列线图。然后，通过bootstrap 重抽样法在验证队列（VC；47 例病例和 94 例对照）中对预测模型进行外部验证。
多变量分析表明，ECOG PS、BMI、T4、N2/3 和再放疗是食管瘘的独立危险因素。然后，构建了一个预测接受放疗的 EC 患者发生食管瘘风险的列线图，其 C 指数为 0.805（95%CI，0.762-0.848）。重要的是，外部验证后 C 指数仍保持在 0.764（95%CI，0.683-0.845）。
我们建立并外部验证了首个与放疗相关的食管瘘风险列线图，这将有助于对发生食管瘘风险的 EC 患者进行个体风险分层。
