Zhou Zihao, Huang Shujie, Ben Xiaosong, Zhuang Weitao, Hong Liangli, Xie Zefeng, Zhang Dongkun, Xie Liang, Zhou Haiyu, Tang Jiming, Chen Gang, Wu Hansheng, Qiao Guibin
Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Shantou University Medical College, Shantou, China.
Ann Transl Med. 2022 Feb;10(4):182. doi: 10.21037/atm-22-46.
This study aimed to establish a reliable model for predicting the overall survival (OS) of esophageal squamous cell carcinoma (ESCC) patients and identifying the potential beneficiaries of adjuvant chemotherapy after esophagectomy.
This retrospective study included 819 ESCC patients who underwent esophagectomy as the training cohort. We constructed a prognostic model named GTLN2. Both internal and external validation tests were performed. Potential beneficiaries were defined as ESCC patients who obtained a significantly longer OS after adjuvant chemotherapy. Propensity score matching (PSM) was utilized in the subgroup analysis to screen ESCC beneficiaries of adjuvant chemotherapy.
We enrolled a total of 819 cT1b-3 patients in the training cohort. Multiple prognostic factors were associated with adjuvant chemotherapy. Using uni-/multivariate analysis, histological grade (G), tumor invasion depth (T), regional lymph node metastasis (N), and the number of cleared lymph nodes (NCLNs) were identified as independent prognostic factors. Then, we developed the GTLN2 model based on these predictors and validated it using internal calculations [the 1-, 3- and 5-year area under the curves (AUCs) were 0.692, 0.685 and 0.680, respectively; P<0.001] and external cohorts (the 1-, 3-, and 5-year AUCs were 0.651, 0.619 and 0.650, respectively; P<0.001). ESCC patients were categorized into high- and low-risk groups based on their assigned risk scores. After 1:1 patient pairing was performed by PSM in the high-risk group, better OS was noted in patients receiving adjuvant chemotherapy (P=0.024).
Differentiating high- and low-risk patient groups via a novel mathematical prediction model allows physicians to identify patients in need of adjuvant chemotherapy accurately.
本研究旨在建立一个可靠的模型，用于预测食管鳞状细胞癌（ESCC）患者的总生存期（OS），并确定食管切除术后辅助化疗的潜在受益人群。
这项回顾性研究纳入了819例行食管切除术的ESCC患者作为训练队列。我们构建了一个名为GTLN2的预后模型。进行了内部和外部验证测试。潜在受益人群定义为接受辅助化疗后OS显著延长的ESCC患者。在亚组分析中采用倾向评分匹配（PSM）来筛选辅助化疗的ESCC受益人群。
训练队列共纳入819例cT1b-3期患者。多个预后因素与辅助化疗相关。通过单因素/多因素分析，组织学分级（G）、肿瘤浸润深度（T）、区域淋巴结转移（N）和清扫淋巴结数量（NCLNs）被确定为独立预后因素。然后，我们基于这些预测因素开发了GTLN2模型，并通过内部计算（1年、3年和5年曲线下面积[AUC]分别为0.692、0.685和0.680；P<0.001）和外部队列（1年、3年和5年AUC分别为0.651、0.619和0.650；P<0.001）进行验证。根据分配的风险评分将ESCC患者分为高风险和低风险组。在高风险组中通过PSM进行1:1患者配对后，接受辅助化疗的患者OS更佳（P=0.024）。
通过一种新的数学预测模型区分高风险和低风险患者群体，使医生能够准确识别需要辅助化疗的患者。
