Center for Gastrointestinal Surgery, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
BMC Cancer. 2021 May 10;21(1):532. doi: 10.1186/s12885-021-08249-x.
The clinical staging systems for adenocarcinoma of the esophagogastric junction (AEG) are controversial. We aimed to propose a prognostic nomogram based on real-world data for predicting survival of Siewert type II/III AEG patients after surgery.
A total of 396 patients with Siewert type II/III AEG diagnosed and treated at the Center for Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-sen University, from June 2009 to June 2017 were enrolled. The original data of 29 variables were exported from the electronic medical records system. The nomogram was established based on multivariate Cox regression coefficients, and its performance was measured using Harrell's concordance index (C-index), receiver operating characteristic (ROC) curve analysis and calibration curve.
A nomogram was constructed based on nine variables. The C-index for overall survival (OS) prediction was 0.76 (95% CI, 0.72 to 0.80) in the training cohort, in the validation-1 cohort was 0.79 (95% CI, 0.72 to 0.86), and 0.73 (95% CI, 0.67 to 0.80) in the validation-2 cohort. Time-dependent ROC curves and calibration curves in all three cohorts showed good prognostic predictive accuracy. We further proved the superiority of the nomogram in predictive accuracy for OS to pathological TNM (pTNM) staging system and other independent prognostic factors. Kaplan-Meier survival curves demonstrated the pTNM stage, grade of differentiation, positive lymph node, log odds of positive lymph node and organ invasion were prognostic factors with good discriminative ability.
The established nomogram demonstrated a more precise prognostic prediction for patients with Siewert type II/III AEG.
食管胃结合部腺癌（AEG）的临床分期系统存在争议。我们旨在基于真实世界的数据提出一个预测 Siewert Ⅱ/Ⅲ型 AEG 患者手术后生存的预后列线图。
共纳入 2009 年 6 月至 2017 年 6 月中山大学附属第一医院胃肠外科诊治的 396 例 Siewert Ⅱ/Ⅲ型 AEG 患者，从电子病历系统中导出 29 个原始变量的数据。列线图基于多变量 Cox 回归系数建立，并使用 Harrell 一致性指数（C-index）、接收者操作特征（ROC）曲线分析和校准曲线来衡量其性能。
基于 9 个变量构建了一个列线图。在训练队列中，总生存（OS）预测的 C-index 为 0.76（95%CI，0.72 至 0.80），在验证-1 队列中为 0.79（95%CI，0.72 至 0.86），在验证-2 队列中为 0.73（95%CI，0.67 至 0.80）。所有三个队列中的时间依赖性 ROC 曲线和校准曲线均显示出良好的预后预测准确性。我们进一步证明了该列线图在 OS 预测准确性方面优于病理 TNM（pTNM）分期系统和其他独立预后因素。Kaplan-Meier 生存曲线表明，pTNM 分期、分化程度、阳性淋巴结、阳性淋巴结对数优势和器官侵犯是具有良好判别能力的预后因素。
建立的列线图为 Siewert Ⅱ/Ⅲ型 AEG 患者提供了更精确的预后预测。
