Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin, China.
Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and PeKing Union Medical College, Shenzhen, China.
Scand J Gastroenterol. 2021 Jun;56(6):635-646. doi: 10.1080/00365521.2021.1910997. Epub 2021 Apr 19.
The aim of this study was to investigate the impact of several common treatment options on the long-term survival of patients with early-stage esophageal cancer and to construct nomograms for survival prediction.
This study was performed using the Surveillance, Epidemiology and End Results (SEER) database (2004-2015) on patients with early-stage (pT1N0M0) esophageal cancer who underwent endoscopic local therapy (ET), radiotherapy (RT), esophagectomy (ES) or neoadjuvant therapy (NT). Multivariate Cox regression was used to explore which factors influenced patient survival, and these factors were then incorporated into propensity sore matching (PSM) and the construction of nomogram plots. Kaplan-Meier analysis was used to compare whether there was a difference in long-term survival between the other three treatments and esophagectomy.
Data from 4184 patients were included in this study. Multivariate Cox regression analysis showed that age, grade, marital status, and treatment method were independent factors affecting survival. After matching, Kaplan-Meier analysis showed that the ET group had better CSS than the ES group, but no difference in OS, while the NT and RT groups had worse OS and CSS than the ES group. In the nomogram prediction model, the c-indexes of the training and validation cohorts were 0.805 and 0.794, respectively. Additionally the ROC curve (5-year AUC = 0.877) and DCA curve showed that the model had a good predictive effect.
For early-stage esophageal cancer, the results of this study showed that ET is not inferior to ES. Based on the independent factors affecting prognosis identified in the study, we constructed and validated a predictive model for predicting long-term survival in patients with early-stage esophageal cancer.
本研究旨在探讨几种常见治疗方案对早期食管癌患者长期生存的影响，并构建生存预测列线图。
本研究使用 Surveillance, Epidemiology and End Results（SEER）数据库（2004-2015 年），纳入接受内镜局部治疗（ET）、放疗（RT）、食管切除术（ES）或新辅助治疗（NT）的早期（pT1N0M0）食管癌患者。多变量 Cox 回归用于探讨影响患者生存的因素，这些因素被纳入倾向评分匹配（PSM）和列线图绘制中。Kaplan-Meier 分析用于比较其他三种治疗方法与 ES 之间是否存在长期生存差异。
本研究纳入了 4184 例患者的数据。多变量 Cox 回归分析显示，年龄、分级、婚姻状况和治疗方法是影响生存的独立因素。匹配后，Kaplan-Meier 分析显示 ET 组的 CSS 优于 ES 组，但 OS 无差异，而 NT 和 RT 组的 OS 和 CSS 均劣于 ES 组。在列线图预测模型中，训练集和验证集的 C 指数分别为 0.805 和 0.794。此外，ROC 曲线（5 年 AUC = 0.877）和 DCA 曲线表明该模型具有良好的预测效果。
对于早期食管癌，本研究结果表明 ET 并不逊于 ES。基于研究中确定的影响预后的独立因素，我们构建并验证了一个预测早期食管癌患者长期生存的预测模型。
