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. 2020 Jul 23;12(14):14736-14753.
doi: 10.18632/aging.103532. Epub 2020 Jul 23.

Prognostic evaluation of esophageal cancer patients with stages I-III

Meng-Jun Qiu  1 , Sheng-Li Yang  2 , Meng-Meng Wang  1 , Ya-Nan Li  1 , Xin Jiang  1 , Zao-Zao Huang  3 , Zhi-Fan Xiong  1
Affiliations

Prognostic evaluation of esophageal cancer patients with stages I-III

Meng-Jun Qiu et al. Aging (Albany NY). .

Abstract

Purpose: The purpose of this study was to investigate the impact of clinicopathological factors and treatments on the overall survival (OS) and esophageal cancer-specific survival (ECSS) of stages I-III esophageal cancer (EC) patients and to establish a prognostic visual nomogram.

Methods: We collected clinical data of patients diagnosed with stages I-III EC without receiving chemotherapy from 2004 to 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. Prognoses were analyzed using the R language software, and nomograms were obtained according to the visual processing logistic regression model, which was verified using the Harrell C-index, receiver operating characteristic (ROC) curve, and calibration curve.

Results: A total of 4,305 patients were selected, mostly white males. Most patients were over 60 years old and old age predicted poor prognosis. EC, primarily adenocarcinoma, occurred mostly in the lower third of the esophagus. About half of the patients had T1 (58.00%) and grade II (50.41%) cancer. Of all the patients, 2,448 was treated with surgery and the majority (n = 1,476; 64.85%) of these patients had stage I EC. Stages I-III patients underwent surgery had significantly better OS and ECSS, and endoscopic therapy was associated with the best outcome amongst all the surgical methods. 3.67% of the patients received radiotherapy, predominantly postoperative radiotherapy (2.69%). Older age, squamous cell carcinoma, overlapping lesion of the esophagus, and grades II and III were high-risk factors for poor OS and ECSS for stage I patients, whereas endoscopic therapy, esophagectomy, and esophagectomy with gastrectomy were low-risk factors. Stage II patients with older age, male sex, T3, N1, and grades II and III had shorter OS and ECSS, but patients with any surgical treatment had significantly longer OS and ECSS. T4, N1, and grade III correlated negatively with OS and ECSS in stage III patients, and any surgical treatment correlated positively with longer OS and ECSS. The OS and ECSS rates of stages I-III EC patients with a total score of more than 150 points in the nomogram were both only 40% after 3 years and 30% after 5 years. The C-index, ROC curve, and calibration curve indicated that the nomograms established in this study were suitable to assess patient prognosis.

Conclusion: The nomogram established in this study is an effective clinical tool to predict the prognosis of stages I-III EC patients without chemotherapy.

Keywords: SEER database; esophageal cancer; nomogram; prognosis; surgery.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Incidence rates (Age-adjusted) and annual percentage change trends of esophageal cancer.
Figure 2
Figure 2
Flow diagram of esophageal cancer patient selection from the SEER database between 2004 and 2014.
Figure 3
Figure 3
Forest plot of the multivariate analysis data of stage I esophageal cancer patients using the Cox proportional hazards model. (A) Multivariate analysis of the overall survival for stage I EC patients. (B) Multivariate analysis of the esophageal cancer-specific survival for stage I EC patients.
Figure 4
Figure 4
Forest plot of the multivariate analysis data of stage II esophageal cancer patients using the Cox proportional hazards model. (A) Multivariate analysis of the overall survival for stage II EC patients. (B) Multivariate analysis of the esophageal cancer-specific survival for stage II EC patients.
Figure 5
Figure 5
Forest plot of the multivariate analysis data of stage III esophageal cancer patients using the Cox proportional hazards model. (A) Multivariate analysis of the overall survival for stage III EC patients. (B) Multivariate analysis of the esophageal cancer-specific survival for stage III EC patients.
Figure 6
Figure 6
Kaplan-Meier survival analyses for overall survival (OS) and esophageal cancer-specific survival (ECSS) in stages I-III esophageal cancer (EC) patients underwent different types of surgery. (A) Survival curve for OS in stages I-III EC patients. (B) Survival curve for OS in stage I EC patients. (C) Survival curve for OS in stage II EC patients. (D) Survival curve for OS in stage III EC patients. (E) Survival curve for OS based on surgery type in stages I-III EC patients. (F) Survival curve for ECSS in stages I-III EC patients. (G) Survival curve for ECSS in stage I EC patients. (H) Survival curve for ECSS in stage II EC patients. (I) Survival curve for ECSS in stage III EC patients. (J) Survival curve for ECSS based on surgery type in stages I-III EC patients. (K) Competitive risk of cancer-induced deaths and non-cancer-related deaths of stages I-III EC patients. (L) Competitive risk of cancer-induced deaths and non-cancer-related deaths of stage I EC patients. (M) Competitive risk of cancer-induced deaths and non-cancer-related deaths of stage II EC patients. (N) Competitive risk of cancer-induced deaths and non-cancer-related deaths of stage III EC patients.
Figure 7
Figure 7
Kaplan-Meier survival analyses for overall survival (OS) and esophageal cancer-specific survival (ECSS) in stages I-III patients with esophageal cancer (EC) based on age. (A) Survival curve for OS in stages I-III EC patients. (B) Survival curve for OS in stage I EC patients. (C) Survival curve for OS in stage II EC patients. (D) Survival curve for OS in stage III EC patients. (E) Survival curve for OS based on age stratification in stages I-III EC patients. (F) Survival curve for ECSS in stages I-III EC patients. (G) Survival curve for ECSS in stage I EC patients. (H) Survival curve for ECSS in stage II EC patients. (I) Survival curve for ECSS in stage III EC patients. (J) Survival curve for ECSS based on age stratification in stages I-III EC patients. (K) Competitive risk of cancer-induced deaths and non-cancer-related deaths of stages I-III EC patients. (L) Competitive risk of cancer-induced deaths and non-cancer-related deaths of stage I EC patients. (M) Competitive risk of cancer-induced deaths and non-cancer-related deaths of stage II EC patients. (N) Competitive risk of cancer-induced deaths and non-cancer-related deaths of stage III EC patients.
Figure 8
Figure 8
The survival nomogram of stages I-III esophageal cancer patients. (A) The sum of these numbers is located on the Total Points axis, and a line is drawn downward to the survival axes to determine the likelihood of a 3- or 5-year OS. (B) The sum of these numbers is located on the Total Points axis, and a line is drawn downward to the survival axes to determine the likelihood of a 3- or 5-year ECSS.
Figure 9
Figure 9
AUC value of the ROC predicting. (A) 3-year OS rates of the nomogram in the training set. (B) 5-year OS rates of the nomogram in the training set. (C) 3-year OS rates of the nomogram in the validation set. (D) 5-year OS rates of the nomogram in the validation set. (E) 3-year ECSS rates of the nomogram in the training set. (F) 5-year ECSS rates of the nomogram in the training set. (G) 3-year OS rates of the nomogram in the validation set. (H) 5-year OS rates of the nomogram in the validation set.
Figure 10
Figure 10
The calibration curve for predicting patient survival. (A) at 3-year OS in the training set; (B) at 5-year OS in the training set; (C) at 3-year OS in the validation set; (D) at 5-year ECSS in the validation set; (E) at 3-year ECSS in the training set; (F) at 5-year ECSS in the training set; (G) at 3-year ECSS in the validation set; (H) at 5-year ECSS in the validation set.
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