A novel prognostic nomogram to predict survival of patients with esophageal squamous cell carcinoma after definitive chemoradiotherapy.

BACKGROUND

Against the backdrop of esophageal cancer's high global incidence, the dominant role of esophageal squamous cell carcinoma (ESCC) with poor prognosis, limited surgical opportunities, and the American Joint Committee on Cancer (AJCC) staging system's insufficiency, there is an urgent need to develop a prognostic nomogram for ESCC patients undergoing chemoradiotherapy. The purpose of this study was to establish a clinical nomogram for effectively predicting overall survival (OS) for patients with non-operated ESCC after definitive chemoradiotherapy.

METHODS

A total of 869 patients diagnosed with ESCC from 2010 to 2015 were retrieved from the Surveillance, Epidemiology, and End Results database. The nomogram was developed based on independent predictors determined by multivariate Cox regression analyses. Additional external validation was conducted on 318 ESCC patients enrolled from The First Affiliated Hospital of Nanjing Medical University. The receiver operating characteristic curve analysis and calibration plot were utilized to assess the predictive discriminative ability and reliability of the nomogram in both the training cohort and external validation cohort. The clinical practicability was evaluated by decision curve analysis and further comparing the novel model and the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.

RESULTS

The multivariate analysis of the training cohort suggested that age, sex, tumor site, tumor size, clinical T stage, clinical N stage were significantly associated with OS and were all incorporated into the nomogram. The results suggested that the novel nomogram performed well with good discrimination and agreement and exhibited more optimal clinical benefits than AJCC 8th staging system. Meanwhile, an online web-server based on the new nomogram was developed for convenient clinical practice.

CONCLUSIONS

The prognostic nomogram developed in this study demonstrates favorable predictive performance for survival outcomes in ESCC patients receiving definitive chemoradiotherapy. Its discriminative ability, consistency, and clinical benefits surpass those of the AJCC 8th Edition staging system. Additionally, a convenient online tool for the nomogram has been developed. This model can objectively quantify patients' survival risks, providing critical reference for the formulation of individualized treatment strategies and possessing clinical application value.