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. 2024 Jul 6:12:goae060.
doi: 10.1093/gastro/goae060. eCollection 2024.

Nomogram for predicting pathologic complete response following preoperative chemoradiotherapy in patients with esophageal squamous cell carcinoma

Young Seob Shin  1 , Jeong Yun Jang  1 , Ye Jin Yoo  1 , Jesang Yu  2 , Kye Jin Song  1 , Yoon Young Jo  3 , Sung-Bae Kim  4 , Sook Ryun Park  4 , Ho June Song  5 , Yong-Hee Kim  6 , Hyeong Ryul Kim  6 , Jong Hoon Kim  1
Affiliations

Nomogram for predicting pathologic complete response following preoperative chemoradiotherapy in patients with esophageal squamous cell carcinoma

Young Seob Shin et al. Gastroenterol Rep (Oxf). .

Abstract

Background: In patients with esophageal squamous cell carcinoma (ESCC), accurately predicting a pathologic complete response (pCR) to preoperative chemoradiotherapy (PCRT) has the potential to enable an active surveillance strategy without esophagectomy. We aimed to establish a reliable multiparameter nomogram model that combines tumor characteristics, imaging modalities, and hematologic markers to predict pCR in patients with ESCC who underwent PCRT and esophagectomy.

Methods: We retrospectively reviewed the medical records of 457 patients with ESCC who received PCRT followed by esophagectomy between January 2005 and October 2020. The nomogram model was developed using logistic regression analysis with a training cohort and externally validated with a validation cohort.

Results: In the training and validation cohorts, 44.2% (126/285) and 48.3% (83/172) of patients, respectively, achieved pCR after PCRT. The 5-year rates of overall survival, progression-free survival, and freedom from local progression in the training cohort were 51.6%, 48.5%, and 77.6%, respectively. The parameters included in the nomogram were histologic grade, clinical N stage, maximum standardized uptake value on positron emission tomography, and post-PCRT biopsy. Hematologic markers were significantly associated with survival outcomes but not with pCR. The area under the receiver operating characteristic curve of the nomogram was 0.717, 0.704, and 0.707 for the training cohort, internal validation cohort, and external validation cohort, respectively.

Conclusion: Our nomogram model based on four parameters obtained from standard clinical practice demonstrated good performance in both the training and validation cohorts and could be useful to aid clinical decision-making to determine whether surgery or active surveillance strategy should be pursued.

Keywords: chemoradiotherapy; esophageal squamous cell carcinoma; esophagectomy; nomograms; treatment outcome.

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Conflict of interest statement

We have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Recurrence and survival outcomes in the training cohort. (A) Overall survival (OS); (B) Progression-free survival (PFS); (C) Freedom from local progression (FFLP).
Figure 2.
Figure 2.
Recurrence and survival outcomes in the training cohort according to pathologic complete response (pCR). (A) Overall survival (OS); (B) Progression-free survival (PFS); (C) Freedom from local progression (FFLP). CR, clinical response.
Figure 3.
Figure 3.
Nomogram for predicting pathologic complete response (pCR). Points for each factor can be read using the top point scale bar. The total points from four factors were used to estimate the probability of pCR on the bottom scale bar. PCRT, preoperative chemoradiotherapy; mSUV, maximum standardized uptake value.
Figure 4.
Figure 4.
Receiver operating characteristic (ROC) curve (A) and calibration plot (B) of the nomogram in the training cohort. AUC, area under the curve.
Figure 5.
Figure 5.
Receiver operating characteristic (ROC) curve (A) and calibration plot (B) of the nomogram in the validation cohort. AUC, area under the curve.
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