State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan Province, China.
Department of Endoscopy, The Third Affiliated Hospital, Nanyang Medical College, Nanyang 473061, Henan Province, China.
World J Gastroenterol. 2022 Apr 7;28(13):1347-1361. doi: 10.3748/wjg.v28.i13.1347.
In China, it has been well recognized that some female patients with esophageal squamous cell carcinoma (ESCC) have different overall survival (OS) time, even with the same tumor-node-metastasis (TNM) stage, challenging the prognostic value of the TNM system alone. An effective predictive model is needed to accurately evaluate the prognosis of female ESCC patients.
To construct a novel prognostic model with clinical and reproductive data for Chinese female patients with ESCC, and to assess the incremental prognostic value of the full model compared with the clinical model and TNM stage.
A new prognostic nomogram incorporating clinical and reproductive features was constructed based on univariatie and Cox proportional hazards survival analysis from a training cohort ( = 175). The results were recognized using the internal ( = 111) and independent external ( = 85) validation cohorts. The capability of the clinical-reproductive model was evaluated by Harrell's concordance index (C-index), Kaplan-Meier curve, time-dependent receiver operating characteristic (ROC), calibration curve and decision curve analysis. The correlations between estrogen response and immune-related pathways and some gene markers of immune cells were analyzed using the TIMER 2.0 database.
A clinical-reproductive model including incidence area, age, tumor differentiation, lymph node metastasis (N) stage, estrogen receptor alpha (ESR1) and beta (ESR2) expression, menopausal age, and pregnancy number was constructed to predict OS in female ESCC patients. Compared to the clinical model and TNM stage, the time-dependent ROC and C-index of the clinical-reproductive model showed a good discriminative ability for predicting 1-, 3-, and 5-years OS in the primary training, internal and external validation sets. Based on the optimal cut-off value of total prognostic scores, patients were classified into high- and low-risk groups with significantly different OS. The estrogen response was significantly associated with p53 and apoptosis pathways in esophageal cancer.
The clinical-reproductive prognostic nomogram has an incremental prognostic value compared with the clinical model and TNM stage in predicting OS in Chinese female ESCC patients.
在中国，人们已经充分认识到，一些患有食管鳞癌（ESCC）的女性患者的总生存（OS）时间不同，即使处于相同的肿瘤-淋巴结-转移（TNM）分期，这对 TNM 系统的预后价值提出了挑战。需要建立一种有效的预测模型来准确评估女性 ESCC 患者的预后。
构建一个新的基于中国女性 ESCC 患者临床和生殖数据的预后模型，并评估全模型与临床模型和 TNM 分期相比的增量预后价值。
利用训练队列（n=175）的单变量和 Cox 比例风险生存分析，构建了一个包含临床和生殖特征的新预后列线图。通过内部（n=111）和独立外部（n=85）验证队列验证了结果。通过 Harrell 的一致性指数（C-index）、Kaplan-Meier 曲线、时间依赖性接受者操作特征（ROC）、校准曲线和决策曲线分析来评估临床-生殖模型的能力。使用 TIMER 2.0 数据库分析雌激素反应与免疫相关途径以及某些免疫细胞基因标志物之间的相关性。
构建了一个包含发病地区、年龄、肿瘤分化、淋巴结转移（N）分期、雌激素受体α（ESR1）和β（ESR2）表达、绝经年龄和妊娠次数的临床-生殖模型，以预测女性 ESCC 患者的 OS。与临床模型和 TNM 分期相比，临床-生殖模型的时间依赖性 ROC 和 C-index 在原发性训练、内部和外部验证集中均显示出较好的预测 1、3 和 5 年 OS 的区分能力。基于总预后评分的最佳截断值，患者被分为高风险和低风险组，两组之间的 OS 差异有统计学意义。雌激素反应与食管癌中的 p53 和凋亡途径显著相关。
与临床模型和 TNM 分期相比，临床-生殖预后列线图在预测中国女性 ESCC 患者 OS 方面具有增量预后价值。
