Chen Mi, Jia Li, Su Zhou
Department of Oncology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China.
Department of Oncology, Mianyang 404 Hospital, Mianyang, China.
Transl Cancer Res. 2025 Aug 31;14(8):4837-4850. doi: 10.21037/tcr-2025-543. Epub 2025 Aug 26.
Esophageal cancer (EC) is a major contributor to cancer-related deaths globally, with significant mortality rates. Neoadjuvant therapy (NAT), involving preoperative chemotherapy or radiation, aims to enhance outcomes in EC when combined with esophagectomy. However, its efficacy varies, necessitating identification of factors influencing survival benefits. This study aims to identify the factors influencing the survival benefit of NAT in patients with EC.
The current retrospective cohort study collected data from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2015. Propensity score matching (PSM) was used to balance baseline characteristics between the NAT and No NAT groups. A Cox model-based residual approach was applied to estimate the likelihood of survival benefit. Logistic regression was used to explore associated factors in the training cohort, and a nomogram was subsequently developed and validated.
In total, 2,755 patients were included in this study. Before PSM, the NAT group had a significantly longer median overall survival (mOS) than the No NAT group (31 21 months, P<0.001). After PSM, the survival advantage of the NAT group persisted (24 21 months, P=0.03). In the training cohort, tumor (T) stage, metastasis (M) stage, tumor grade, and lymph node ratio (LNR) appeared to be associated with survival benefit among patients receiving NAT. A nomogram was subsequently constructed based on these factors to estimate the likelihood of deriving benefit from NAT. In the validation cohort, the model exhibited reasonable discriminatory performance, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.782.
This study identified clinical features potentially associated with survival benefit from NAT in patients with EC. The nomogram may serve as a reference tool to support treatment planning and patient selection in clinical practice.
食管癌（EC）是全球癌症相关死亡的主要原因之一，死亡率很高。新辅助治疗（NAT），包括术前化疗或放疗，旨在与食管切除术联合应用时提高食管癌的治疗效果。然而，其疗效存在差异，因此需要确定影响生存获益的因素。本研究旨在确定影响食管癌患者新辅助治疗生存获益的因素。
本项回顾性队列研究收集了2004年至2015年监测、流行病学和最终结果（SEER）数据库中的数据。采用倾向评分匹配（PSM）来平衡新辅助治疗组和非新辅助治疗组之间的基线特征。应用基于Cox模型的残差方法来估计生存获益的可能性。使用逻辑回归在训练队列中探索相关因素，随后构建并验证了列线图。
本研究共纳入2755例患者。在倾向评分匹配之前，新辅助治疗组的中位总生存期（mOS）明显长于非新辅助治疗组（31对21个月，P<0.001）。倾向评分匹配后，新辅助治疗组的生存优势依然存在（24对21个月，P=0.03）。在训练队列中，肿瘤（T）分期、转移（M）分期、肿瘤分级和淋巴结比率（LNR）似乎与接受新辅助治疗患者的生存获益相关。随后基于这些因素构建了列线图，以估计从新辅助治疗中获益的可能性。在验证队列中，该模型表现出合理的区分性能，受试者操作特征（ROC）曲线下面积（AUC）为0.782。
本研究确定了可能与食管癌患者新辅助治疗生存获益相关的临床特征。该列线图可作为临床实践中支持治疗计划和患者选择的参考工具。
