Prognosis prediction in esophageal signet-ring-cell carcinoma: a competing risk analysis

Abstract

Objective: This study aims to construct and validate a competing risk nomogram model to predict 1-year, 3-year, and 5-year cancer-specific survival (CSS) for patients with esophageal signet-ring-cell carcinoma.

Methods: Patients diagnosed with esophageal signet-ring-cell carcinoma (ESRCC) between 2010 and 2015 were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database. We performed the competing risk model to select significant variables to build a competing risk nomogram, which was used to estimate 1-year, 3-year, and 5-year CSS probability. The C-index, receiver operating characteristic (ROC) curve, calibration plot, Brier score, and decision curve analysis were performed in the internal validation.

Results: A total of 564 patients with esophageal signet-ring-cell carcinoma fulfilled the eligibility criteria. The competing risk nomogram identified 4 prognostic variables, involving the gender, lung metastases, liver metastases, and receiving surgery. The C indexes of nomogram were 0.61, 0.75, and 0.70, respectively for 5-year, 3-year, and 1-year CSS prediction. The calibration plots displayed high consistency. The Brier scores and decision curve analysis respectively favored good prediction ability and clinical utility of the nomogram.

Conclusions: A competing risk nomogram for esophageal signet-ring-cell carcinoma was successfully constructed and internally validated. This model is expected to predict 1-year, 3-year, and 5-year CSS, and help oncologists and pathologists in clinical decision making and health care management for esophageal signet-ring-cell carcinoma patients.

Keywords: Competing risk nomogram; Esophageal carcinoma; Prognosis prediction; SEER; Signet-ring-cell.

Fig. 1

Flowchart of study design and patient selection

Fig. 2

Cumulative incidence plot depicting cancer-caused death and other cause mortality based on clinicopathological features. Subgroups are respectively age (A), sex (B), race (C), material status (D), history of malignancy (E), primary site (F), AJCC stage (G), grade (H), tumor size (I), node status (J), regional nodes examined (K), positive lymph nodes (L), bone metastases (M), liver metastases (N), lung metastases (O), surgery (P), radiotherapy (Q), chemotherapy (R)

Fig. 3

A competing risk nomogram predicting 1-year, 3-year, and 5-year cancer-specific survival probability of patients with esophageal signet-ring-cell carcinoma. ***P < 0.05, **P < 0.1

Fig. 4

Receiver operating characteristics (ROC) curves and calibration plots for the 1-, 3-, and 5-year cancer-specific survival of BIC-nomogram and ALL-model. (A-B) ROC curves of the training set; (C-D) ROC curves of the validation set; (E–F) calibration plots of the training set; (G-H) calibration plots of the validation set. AUC, area under the curve

Fig. 5

Decision curves for nomogram to predict 1-, 3-, and 5- year cancer-specific survival in the training set (A-D) and validation set (E–H). DCA, decision curve analysis; ALL-model, including all covariates; BIC-model, including selected variables

Fig. 6

Subgroup analysis with cumulative incidence plots according to sex (A), receiving surgery (B), lung metastases (C), liver metastases (D)