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. 2022 Jul 7:12:925685.
doi: 10.3389/fonc.2022.925685. eCollection 2022.

A Nomogram Model to Predict Post-Progression Survival in Esophageal Squamous Cell Carcinoma Patients With Recurrence After Radical Resection

Changsen Leng  1   2   3 , Yingying Cui  1   4 , Junying Chen  1   2   3 , Kexi Wang  5 , Hong Yang  1   2   3 , Jing Wen  1   3 , Jianhua Fu  1   2   3 , Qianwen Liu  1   2   3
Affiliations

A Nomogram Model to Predict Post-Progression Survival in Esophageal Squamous Cell Carcinoma Patients With Recurrence After Radical Resection

Changsen Leng et al. Front Oncol. .

Abstract

Background: Esophageal squamous cell carcinoma (ESCC) is characterized clinically by frequent recurrence, leading to a poor prognosis after radical surgery. The aim of this study was to identify a prognostic nomogram to predict the post-progression survival (PPS) of ESCC patients based on the features of primary tumor and recurrence.

Methods: A total of 234 ESCC patients who underwent recurrence after radical surgery were enrolled in this study. The independent prognostic factors screened by the univariate and multivariate Cox regression analysis were subsequently used to construct a nomogram. The predictive performance of the nomogram was evaluated with the concordance index (C-index), decision curve, and the area under the receiver operating characteristic curve (AUC) and validated in two validation cohorts. The Kaplan-Meier curves of different recurrence patterns were analyzed.

Results: The prognostic nomogram of PPS was established by integrating independent prognostic factors, including age, body mass index, number of lymph node dissection, recurrence pattern, and recurrence treatment. The nomogram demonstrated good performance, with C-index values of 0.756, 0.817, and 0.730 for the training and two validation cohorts. The 1-year AUC values were 0.773, 0.798, and 0.735 and 3-year AUC values were 0.832, 0.871, and 0.791, respectively. Furthermore, we found that patients with bone metastasis displayed the worst PPS compared to other isolated recurrence patterns.

Conclusion: We constructed a nomogram to reliably predict PPS, which would be valuable to provide individual managements for ESCC patients after radical surgery.

Keywords: esophageal squamous cell carcinoma (ESCC); nomogram; post-progression survival; prognostic model; recurrence.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Feature selection using the least absolute shrinkage and selection operator (LASSO) Cox regression model. LASSO coefficient profiles of variables against the log lambda sequence for PPS (A) and tuning parameter (λ) selection in the LASSO model for PPS (B).
Figure 2
Figure 2
A prognostic nomogram for estimating the 1- and 3-year post-progression survival rates in the ESCC patients with recurrence after surgery.
Figure 3
Figure 3
The calibration curves for predicting post-progression survival of ESCC patients at 1- and 3-year in the training cohort (A, D), validation cohort 1 (B, E), and validation cohort 2 (C, F), respectively.
Figure 4
Figure 4
The receiver operating characteristic (ROC) curves for predicting post-progression survival of ESCC patients at 1- and 3-year in the training cohort (A, D), validation cohort 1 (B, E), and validation cohort 2 (C, F), respectively.
Figure 5
Figure 5
Decision curve analysis (DCA) for the nomogram model in the training cohort (A), validation cohort 1 (B), and validation cohort 2 (C) for PPS. The red lines represent the DCA of the nomogram.
Figure 6
Figure 6
The Kaplan-Meier curves for the risk subgroups of ESCC patients. Patients were stratified by the prognostic score of the nomogram in the training cohort (A), validation cohort 1 (B), and validation cohort 2 (C). Stratification of patients by significant characteristics after multivariate analysis in the training cohort: age (D), BMI (E), number of LND (F), recurrence pattern (G), and recurrence treatment (H).
Figure 7
Figure 7
The comparison of post-progression survival of ESCC patients with different recurrence patterns in the training cohort. Comparisons of the post-progression survival based on the following distant recurrence patterns: bone only vs. lung only (A); bone only vs. liver only (B); lung only vs. pleura only (C); liver only vs. pleura only (D); bone only vs. pleura only (E); liver only vs. lung only (F). Comparisons of the post-progression survival based on the following local-regional recurrence patterns: anastomotic only vs. cervical only (G); anastomotic only vs. mediastinal only (H); abdominal only vs. anastomotic only (I); cervical only vs. mediastinal only (J); abdominal only vs. cervical only (K); abdominal only vs. mediastinal only (L).
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