Wang Xiao-Mei, Liu Can-Tong, Huang Jia-Tao, Zhang Zhi-Han, Xu Yi-Wei, Wu Fang-Cai, Peng Yu-Hui
Department of Clinical Laboratory Medicine, The Cancer Hospital of Shantou University Medical College, Shantou, China.
Esophageal Cancer Prevention and Control Research Center, The Cancer Hospital of Shantou University Medical College, Shantou, China.
Front Oncol. 2025 Apr 28;15:1547462. doi: 10.3389/fonc.2025.1547462. eCollection 2025.
The purpose of this study was to investigate the impact of clinicopathological factors on the overall survival (OS) of advanced esophageal squamous cell carcinoma (ESCC) patients with both lymph node and distant metastasis and build a nomogram for OS prediction.
We selected 621 ESCC patients with cT1-4N1-3M1 stage without surgical treatment from the Surveillance, Epidemiology, and End Results (SEER) database and randomized (in a 7:3 ratio) to the training cohort and internal validation cohort. Another 159 patients were enrolled from the Cancer Hospital of Shantou University Medical College as the external validation cohort. A nomogram was developed based on independent risk factors that resulted from a multivariate Cox regression analysis. Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were used to evaluate the discriminative ability and calibration curves were constructed to evaluate the calibration ability. Kaplan-Meier survival analysis and log-rank tests were then used to predict the further OS status of these patients.
The multivariate Cox regression analysis revealed that sex, T stage, radiotherapy, and chemotherapy were independent prognostic factors for ESCC patients with cT1-4N1-3M1 stage. All these factors were incorporated to construct a nomogram. The prognostic nomogram in training cohort exhibited the AUCs of 0.784, 0.746, and 0.735 for predicting 6-, 9-, and 12-month OS, respectively. Calibration curves exhibited that the nomogram-predicted OS were insistent with the actual OS. In validation cohorts, the nomogram still showed acceptable discrimination ability and calibration. All individuals were allocated into high-risk versus low-risk groups based on the median risk score of the training cohort. The OS of the high-risk group was shorter than that of the low-risk group in three cohorts.
We developed and validated an individualized survival prediction nomogram for predicting OS in ESCC patients with cT1-4N1-3M1 stage, which may help clinicians to assess the situation of advanced ESCC patients and implement further treatment.
本研究旨在探讨临床病理因素对伴有淋巴结和远处转移的晚期食管鳞状细胞癌（ESCC）患者总生存期（OS）的影响，并构建用于OS预测的列线图。
我们从监测、流行病学和最终结果（SEER）数据库中选取621例未接受手术治疗的cT1-4N1-3M1期ESCC患者，并按7:3的比例随机分为训练队列和内部验证队列。另外159例患者来自汕头大学医学院附属肿瘤医院，作为外部验证队列。基于多变量Cox回归分析得出的独立危险因素构建列线图。采用受试者工作特征（ROC）曲线及ROC曲线下面积（AUC）评估其判别能力，并构建校准曲线评估校准能力。然后采用Kaplan-Meier生存分析和对数秩检验预测这些患者的进一步OS状态。
多变量Cox回归分析显示，性别、T分期、放疗和化疗是cT1-4N1-3M1期ESCC患者的独立预后因素。将所有这些因素纳入构建列线图。训练队列中的预后列线图预测6个月、9个月和12个月OS的AUC分别为0.784、0.746和0.735。校准曲线显示列线图预测的OS与实际OS一致。在验证队列中，列线图仍显示出可接受的判别能力和校准效果。根据训练队列的中位风险评分将所有个体分为高风险组和低风险组。在三个队列中，高风险组的OS均短于低风险组。
我们开发并验证了一种个体化生存预测列线图，用于预测cT1-4N1-3M1期ESCC患者的OS，这可能有助于临床医生评估晚期ESCC患者的情况并实施进一步治疗。
