Li Xiaomei, Li Daosheng, Qin Shuming, Ye Hong, Lin Min
Department of Pathology, The Affiliated Taian City Central Hospital of Qingdao University, Taian, China.
J Thorac Dis. 2024 Oct 31;16(10):6452-6461. doi: 10.21037/jtd-24-742. Epub 2024 Oct 21.
There is a large variance in the long-term survival of esophageal cancer (EC) patients with metastasis after treatment. This study was designed to analyze long-term survival of metastatic EC patients after surgery, radiotherapy and chemotherapy.
A retrospective cohort of EC patients with metastasis received surgery, radiotherapy and chemotherapy from 2004 to 2015 was obtained from the Surveillance, Epidemiology and End Results (SEER) database. Univariate Cox and complete subset regression analyses were performed to select prognostic factors. Nomograms were established to predict 3-, 5-, and 8-year overall survival (OS), and their performance was evaluated by receiver operating characteristic (ROC) curve and calibration curve.
Age at diagnosis [hazard ratio (HR): 1.01; 95% confidence interval (CI): 1.00, 1.02; P=0.04], EC of other sites (HR: 1.78; 95% CI: 1.29, 2.45; P<0.001), lymph node involvement (HR: 1.37; 95% CI: 1.08, 1.37; P=0.009), and poorly differentiated or undifferentiated (grade III or IV) (HR: 1.39; 95% CI: 1.20, 1.76; P=0.006) was the independent risk factors for poor OS in EC patients. Female (HR: 0.58; 95% CI: 0.38, 0.88; P=0.01) showed reduced risks of showing poor OS compared with male population. The established nomograms based on these predictors showed satisfactory discrimination efficacy for predicting 3-, 5-, and 8-year OS in metastatic EC patients after treatment.
The nomograms showed good efficacy in predicting 3-, 5-, and 8-year OS among metastatic EC patients after surgery, radiotherapy and chemotherapy.
食管癌（EC）患者治疗后发生转移，其长期生存率存在很大差异。本研究旨在分析转移性EC患者接受手术、放疗和化疗后的长期生存情况。
从监测、流行病学和最终结果（SEER）数据库中获取2004年至2015年接受手术、放疗和化疗的转移性EC患者的回顾性队列。进行单因素Cox分析和完全子集回归分析以选择预后因素。建立列线图以预测3年、5年和8年总生存期（OS），并通过受试者工作特征（ROC）曲线和校准曲线评估其性能。
诊断时年龄[风险比（HR）：1.01；95%置信区间（CI）：1.00，1.02；P=0.04]、其他部位的EC（HR：1.78；95%CI：1.29，2.45；P<0.001）、淋巴结受累（HR：1.37；95%CI：1.08，1.37；P=0.009）以及低分化或未分化（III级或IV级）（HR：1.39；95%CI：1.20，1.76；P=0.006）是EC患者OS较差的独立危险因素。与男性相比，女性（HR：0.58；95%CI：0.38，0.88；P=0.01）显示出较差OS风险降低。基于这些预测因素建立的列线图在预测治疗后转移性EC患者的3年、5年和8年OS方面显示出令人满意的区分效果。
列线图在预测转移性EC患者接受手术、放疗和化疗后的3年、5年和8年OS方面显示出良好效果。
