Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan-Dec:30:10732748231185025.
doi: 10.1177/10732748231185025.

The Prognostic Significance of Nomogram-Based Pretreatment Inflammatory Indicators in Patients With Esophageal Squamous Cell Carcinoma Receiving Intensity-Modulated Radiotherapy

Zhiyang Xu  1 , Hongqian Ke  2 , Binglin Zheng  2 , Chuyan Lin  2 , Yiping Zhang  2 , Liyan Wang  2 , Yu Lin  3 , Yuling Ye  2 , Lifang Cai  4 , Mengxing You  4 , Junqiang Chen  3 , Yuanji Xu  3
Affiliations

The Prognostic Significance of Nomogram-Based Pretreatment Inflammatory Indicators in Patients With Esophageal Squamous Cell Carcinoma Receiving Intensity-Modulated Radiotherapy

Zhiyang Xu et al. Cancer Control. 2023 Jan-Dec.

Abstract

Background: At present, there is no objective prognostic index available for patients with esophageal squamous cell carcinoma (ESCC) who underwent intensity-modulated radiotherapy (IMRT). This study is to develop a nomogram based on hematologic inflammatory indices for ESCC patients treated with IMRT.

Methods: 581 patients with ESCC receiving definitive IMRT were enrolled in our retrospective study. Of which, 434 patients with treatment-naïve ESCC in Fujian Cancer Hospital were defined as the training cohort. Additional 147 newly diagnosed ESCC patients were used as the validation cohort. Independent predictors of overall survival (OS) were employed to establish a nomogram model. The predictive ability was evaluated by time-dependent receiver operating characteristic curves, the concordance index (C-index), net reclassification index (NRI), and integrated discrimination improvement (IDI). Decision curve analysis (DCA) was performed to assess the clinical benefits of the nomogram model. The entire series was divided into 3 risk subgroups stratified by the total nomogram scores.

Results: Clinical TNM staging, primary gross tumor volume, chemotherapy, neutrophil-to-lymphocyte ratio and platelet lymphocyte ratio were independent predictors of OS. Nomogram was developed incorporating these factors. Compared with the 8th American Joint Committee on Cancer (AJCC) staging, the C-index for 5-year OS (.627 and .629) and the AUC value of 5-year OS (.706 and .719) in the training and validation cohorts (respectively) were superior. Furthermore, the nomogram model presented higher NRI and IDI. DCA also demonstrated that the nomogram model provided greater clinical benefit. Finally, patients with <84.8, 84.8-151.4, and >151.4 points were categorized into low-risk, intermediate-risk, and high-risk groups. Their 5-year OS rates were 44.0%, 23.6%, and 8.9%, respectively. The C-index was .625, which was higher than the 8th AJCC staging.

Conclusions: We have developed a nomogram model that enables risk-stratification of patients with ESCC receiving definitive IMRT. Our findings may serve as a reference for personalized treatment.

Keywords: esophageal squamous cell carcinoma; intensity-modulated radiotherapy; nomogram; prognosis; risk-stratification.

PubMed Disclaimer

Conflict of interest statement

he author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Nomogram model for prediction of 1-, 3-, and 5-year overall survival (OS) in ESCC patients in the training cohort.
Figure 2.
Figure 2.
A. Receiver operating characteristic (ROC) curves by nomogram for 3-year and 5-year OS in the primary cohort (PC) (red line: 3-year OS; blue line: 5-year OS); B. Calibration curve for 5-year OS prediction according to the PC nomogram; C. ROC curves by nomogram for 3-year and 5-year OS validation cohort (VC) (red line: 3-year OS; blue line: 5-year OS); D. Calibration curve for predicting 5-year OS according to the VC nomogram.
Figure 3.
Figure 3.
Decision curve analysis of the nomogram (blue line), the AJCC stage (red line),and GTVp (green line) for 5-year OS in the primary cohort (PC).
Figure 4.
Figure 4.
Kaplan–Meier overall survival (OS) curves for A. groups disaggregated by the AJCC staging and B. risk group based on the nomogram model in the entire cohort.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Sung H, Ferlay J, Siegel RL, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. - PubMed
    1. Smyth EC, Lagergren J, Fitzgerald RC, et al.Oesophageal cancer. Nat Rev Dis Primers. 2017;3:17048. - PMC - PubMed
    1. Ajani JA, D'Amico TA, Bentrem DJ, et al.Esophageal and Esophagogastric junction cancers, Version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2019;17(7):855-883. - PubMed
    1. Chen H, Zhou L, Yang Y, Yang L, Chen L. Clinical effect of radiotherapy combined with chemotherapy for non-surgical treatment of the Esophageal Squamous cell Carcinoma. Med Sci Monit. 2018;24:4183-4191. - PMC - PubMed
    1. Fan XW, Wang HB, Mao JF, Li L, Wu KL. Sequential boost of intensity-modulated radiotherapy with chemotherapy for inoperable esophageal squamous cell carcinoma: A prospective phase II study. Cancer Med. 2020;9(8):2812-2819. - PMC - PubMed