Zhang Mingxin, Cui Manli, Zuo Qianqian, Wang Li, Wang Jia, Zhu Lin, Yan Rong, Lu Ning, Yan Honglin, Zhang Lingmin
Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China.
Department of Internal Medicine, The Second Clinical Medical College of Shaanxi University of Chinese Medicine, Xianyang, China.
J Gastrointest Oncol. 2021 Aug;12(4):1241-1254. doi: 10.21037/jgo-21-429.
Although the current treatment for esophageal cancer has great technological progress, the 5-year survival rate of patients is not optimistic. About 70% of patients with esophageal cancer are at an advanced stage at first diagnosis. These patients are prone to distant metastasis, and the prognosis is poor. Therefore, understanding the risk factors for distant metastasis in patients with esophageal cancer, combined with the prognosis of the patient, can aid in choosing the optimal diagnosis and treatment plan. Ultimately, it will improve the patient's survival time and quality of life. This research aims to construct a model for the risk assessment of distant metastasis in patients with esophageal cancer and prognostic models for patients with distant and non-distant metastases.
The Surveillance Epidemiology and End Results (SEER) database was used to select patients with esophageal cancer from 2010 to 2015. The optimal cutoff point was selected for the age and tumor size variables using X-tile. The nomogram was constructed using R software (The R Foundation for Statistical Computing).
Gender, grade, T stage, N stage, and tumor size were independent risk factors associated with distant metastasis in patients with esophageal cancer. The concordance index (C-index) of the nomogram prediction model for whether the patient will have distant metastasis was 0.609. Age, grade, T stage, N stage, and tumor size were independent risk factors affecting the prognosis without distant metastasis. The C-index of the nomogram prediction model for patients with distant metastases was 0.590. Age and T stage were independent risk factors affecting the prognosis of patients with distant metastases. The C-index of the nomogram prediction model was 0.543. The combination of radiotherapy, chemotherapy, and primary surgery yielded the best overall survival for both patients with distant metastases and patients with non-distant metastases.
A comprehensive assessment of the risk of distant metastasis in patients with esophageal cancer, combined with prognosis prediction, is necessary to provide patients with a reasonable treatment plan.
尽管目前食管癌的治疗技术有了很大进步，但患者的5年生存率并不乐观。约70%的食管癌患者在初次诊断时已处于晚期。这些患者容易发生远处转移，预后较差。因此，了解食管癌患者远处转移的危险因素，并结合患者的预后情况，有助于选择最佳的诊断和治疗方案。最终，这将提高患者的生存时间和生活质量。本研究旨在构建食管癌患者远处转移风险评估模型以及远处转移和非远处转移患者的预后模型。
使用监测、流行病学和最终结果（SEER）数据库选取2010年至2015年的食管癌患者。使用X-tile软件为年龄和肿瘤大小变量选择最佳截断点。使用R软件（R统计计算基金会）构建列线图。
性别、分级、T分期、N分期和肿瘤大小是食管癌患者远处转移的独立危险因素。患者是否会发生远处转移的列线图预测模型的一致性指数（C指数）为0.609。年龄、分级、T分期、N分期和肿瘤大小是影响无远处转移患者预后的独立危险因素。远处转移患者列线图预测模型的C指数为0.590。年龄和T分期是影响远处转移患者预后的独立危险因素。列线图预测模型的C指数为0.543。放疗、化疗和原发手术联合应用对远处转移患者和非远处转移患者均产生了最佳的总生存期。
对食管癌患者远处转移风险进行综合评估，并结合预后预测，对于为患者提供合理的治疗方案是必要的。
