The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China.
Department of Thoracic Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu Province, China.
Medicine (Baltimore). 2023 Aug 4;102(31):e34189. doi: 10.1097/MD.0000000000034189.
Lymphatic metastasis (LM) is a significant mechanism for the spread of esophageal cancer (EC) and predicts the poor prognosis of EC patients. This research aimed to assess the survival of patients with LM from EC by developing a nomogram. In this retrospective study, EC patients with LM from 2004 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were divided by year of diagnosis into a training cohort and a validation cohort. Univariate and multivariate Cox regression analyses were employed to determine the prognostic factors of LM, and a nomogram was constructed. The discrimination and calibration of the nomogram were compared by the C-index, area under the curve value, and calibration plots. The survival time difference was compared using Kaplan-Meier curves. A total of 11,695 patients with EC were included in this analysis. LM occurred in 56.5% (n = 6614) of EC patients. In the post-propensity score matching (PSM) cohort, patients with LM had significantly lower median overall survival (OS) than those without LM. Multivariate Cox regression was used to identify the eleven independent prognostic factors. The C-index was 0.709 in both the training and test sets, revealing the good predictive performance of the nomogram. Based on the results of calibration plots and the receiver operating characteristic (ROC) curve, we demonstrate the great performance of the prognostic model. The survival time of EC patients with LM was remarkably lower than that of EC patients without LM. The nomogram model established in this study can precisely predict the survival of EC patients with LM.
淋巴转移（LM）是食管癌（EC）扩散的重要机制，并预测 EC 患者的预后不良。本研究旨在通过建立列线图来评估 LM 患者的 EC 患者的生存情况。
在这项回顾性研究中，我们将 2004 年至 2015 年在监测、流行病学和最终结果（SEER）数据库中诊断为 LM 的 EC 患者按诊断年份分为训练队列和验证队列。我们采用单因素和多因素 Cox 回归分析来确定 LM 的预后因素，并构建列线图。我们通过 C 指数、曲线下面积值和校准图比较了列线图的区分度和校准度。我们通过 Kaplan-Meier 曲线比较了生存时间的差异。
共有 11695 名 EC 患者纳入本分析。在 EC 患者中，LM 发生率为 56.5%（n=6614）。在倾向评分匹配（PSM）队列后，LM 患者的中位总生存期（OS）明显低于无 LM 患者。多因素 Cox 回归分析确定了 11 个独立的预后因素。在训练集和测试集中，C 指数分别为 0.709，表明列线图具有良好的预测性能。基于校准图和接收者操作特征（ROC）曲线的结果，我们展示了预测模型的出色表现。LM 患者的 EC 患者的生存时间明显低于无 LM 患者的 EC 患者。本研究建立的列线图模型可以准确预测 LM 患者的 EC 患者的生存情况。
