Gastrointestinal Cancer

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SU_7_2063 - Nomogram to predict disease-free survival in stage IB-III thoracic esophageal squamous cell carcinoma patients after radical esophagectomy

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Nomogram to predict disease-free survival in stage IB-III thoracic esophageal squamous cell carcinoma patients after radical esophagectomy
W. Deng1, J. Q. Chen2, Z. Xiao1, W. Ni1, C. Li1, X. Chang1, J. Yang3, S. F. Yu4, W. Zhang5, Z. Zhou6, D. Chen1, F. Qinfu1, X. Chen7, Y. Lin2, K. Zhu7, J. He8, S. Gao8, Q. Xue8, Y. Mao8, G. Cheng8, K. Sun8, X. Liu8, and D. Fang8; 1Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 2Department of Radiation Oncology, Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou, China, 3Department of Radiation Oncology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China, 4Department of radiotherapy, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China, 5Department of Radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention Therapy, Tianjin, China, 6Department of Radiation Oncology, National Cancer Center / Cancer Institute & Hospital, Chinese Academic of Medical Sciences, Peking Union Medical College, Beijing, China, 7Departments of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China, 8Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Purpose/Objective(s): Retrospective studies have shown that overall recurrence rate was between 43.3%-52.4% for esophageal carcinoma after radical esophagectomy, local-regional recurrence accounts for the major part. However, it did not reach a consensus that whether to apply adjuvant therapy (especially radiotherapy) and its target patients group. This study aims to build a nomogram to identify high risk patients in thoracic esophageal squamous cell carcinoma, and provide evidence for adjuvant radiotherapy.

Materials/Methods: We retrospectively reviewed pT2-4aN0-3 thoracic esophageal squamous cell carcinoma patients after radical esophagectomy with or without adjuvant therapy from 2004-2012 in National Cancer Center/ Cancer Hospital, Chinese Academy of Medical Sciences as training cohort. Nomogram was established using Cox proportional hazard regression model to identify clinical prognostic factors for disease-free survival (DFS). Total scores according to each variable were calculated and stratified to predict DFS. Comparable patients in Fujian Province Cancer Hospital were selected to validate this nomogram. Calibration plot and area under curve (AUC) of receiver operating characteristic (ROC) were calculated to evaluate predicative liability and efficacy.

Results: There are 2352 patients in training cohort, the median follow-up time was 64.1 months, 1406 patients (60.0%) occurred recurrence or death. The median and 5-year DFS were 29.7 months and 39.5% respectively. Adjuvant therapy, sex, tumor location, grade, lymphovascular invasion, dissected lymph nodes, T and N stage were identified as DFS predictive factors to establish nomogram. A total of 1577 patients were in validation cohort, 824 patients (52.3%) had recurrence or death. The median and 5-year DFS were 41.5 months and 43.9% at a median follow-up time of 66.6 months. Calibration plots for both cohort revealed good predictive efficacy. The 1-, 3-, 5- year AUC of ROC curve were 0.68, 0.71, 0.71 and 0.70, 0.73, 0.73 in training and validation cohort respectively. When applying UICC staging system (2009) to predict DFS in both cohort, IIIB and IIIC could not separate each other well (5-year DFS, 18.7% vs. 20.3% in training cohort, 18.6% vs. 14.6% in validation cohort, p>0.05). While using nomogram score to divide patients into six groups, each group showed significant different DFS (5-year DFS for each group: 60.8%, 48.6%, 33.6%, 24.3%, 15.8% and 10.7%, p<0.05 for pairwise comparisons).

Conclusion: This nomogram is a useful and efficient tool to predict DFS for thoracic esophageal squamous cell carcinoma patients. Applying nomogram score could identify high risk patients, who may become potential candidates for further treatment.

Author Disclosure: W. Deng: None. W. Ni: None. X. Chang: None. Y. Lin: None.

Wei Deng, MD

National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences

Disclosure:
No relationships to disclose.

Biography:
Wei Deng, M.D. is a postgraduate student at the Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. She is also currently a Research Medical Student at Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center. Her research interests include treatment strategies, risk prediction, and immune system functions during chemoradiation for esophageal carcinoma.

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