Influential factors affecting the survival benefit of combined neoadjuvant therapy and esophagectomy in patients with esophageal cancer: an analysis based on the SEER database.

IF 1.7 4区医学 Q4 ONCOLOGY

Translational cancer research Pub Date : 2025-08-31 Epub Date: 2025-08-26 DOI:10.21037/tcr-2025-543

Mi Chen, Li Jia, Zhou Su

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Abstract

Background: Esophageal cancer (EC) is a major contributor to cancer-related deaths globally, with significant mortality rates. Neoadjuvant therapy (NAT), involving preoperative chemotherapy or radiation, aims to enhance outcomes in EC when combined with esophagectomy. However, its efficacy varies, necessitating identification of factors influencing survival benefits. This study aims to identify the factors influencing the survival benefit of NAT in patients with EC.

Methods: The current retrospective cohort study collected data from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2015. Propensity score matching (PSM) was used to balance baseline characteristics between the NAT and No NAT groups. A Cox model-based residual approach was applied to estimate the likelihood of survival benefit. Logistic regression was used to explore associated factors in the training cohort, and a nomogram was subsequently developed and validated.

Results: In total, 2,755 patients were included in this study. Before PSM, the NAT group had a significantly longer median overall survival (mOS) than the No NAT group (31 vs. 21 months, P<0.001). After PSM, the survival advantage of the NAT group persisted (24 vs. 21 months, P=0.03). In the training cohort, tumor (T) stage, metastasis (M) stage, tumor grade, and lymph node ratio (LNR) appeared to be associated with survival benefit among patients receiving NAT. A nomogram was subsequently constructed based on these factors to estimate the likelihood of deriving benefit from NAT. In the validation cohort, the model exhibited reasonable discriminatory performance, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.782.

Conclusions: This study identified clinical features potentially associated with survival benefit from NAT in patients with EC. The nomogram may serve as a reference tool to support treatment planning and patient selection in clinical practice.

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影响食管癌患者新辅助治疗联合食管切除术生存获益的影响因素：基于SEER数据库的分析

背景：食管癌（EC）是全球癌症相关死亡的主要原因，死亡率很高。新辅助治疗（NAT），包括术前化疗或放疗，旨在提高食管切除术合并EC的预后。然而，其疗效各不相同，因此有必要确定影响生存益处的因素。本研究旨在确定影响NAT治疗EC患者生存获益的因素。方法：本回顾性队列研究收集了2004年至2015年监测、流行病学和最终结果（SEER）数据库中的数据。倾向评分匹配（PSM）用于平衡NAT和No NAT组之间的基线特征。采用基于Cox模型的残差法估计生存获益的可能性。使用逻辑回归来探索训练队列中的相关因素，并随后开发和验证了nomogram。结果：共纳入2755例患者。在PSM之前，NAT组的中位总生存期（mOS）明显长于无NAT组（31个月vs 21个月，pv . 21个月，P=0.03）。在训练队列中，肿瘤(T)分期、转移(M)分期、肿瘤分级和淋巴结比例（LNR）似乎与接受NAT治疗的患者的生存获益相关。随后，基于这些因素构建了一个nomogram，以估计从NAT治疗中获益的可能性。在验证队列中，该模型表现出合理的区分性能，受试者工作特征（ROC）曲线下面积（AUC）为0.782。结论：本研究确定了与EC患者NAT治疗的生存获益潜在相关的临床特征。在临床实践中，该图可作为支持治疗计划和患者选择的参考工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Translational cancer research ONCOLOGY-

CiteScore

2.10

自引率

0.00%

发文量

252

期刊介绍： Translational Cancer Research (Transl Cancer Res TCR; Print ISSN: 2218-676X; Online ISSN 2219-6803; http://tcr.amegroups.com/) is an Open Access, peer-reviewed journal, indexed in Science Citation Index Expanded (SCIE). TCR publishes laboratory studies of novel therapeutic interventions as well as clinical trials which evaluate new treatment paradigms for cancer; results of novel research investigations which bridge the laboratory and clinical settings including risk assessment, cellular and molecular characterization, prevention, detection, diagnosis and treatment of human cancers with the overall goal of improving the clinical care of cancer patients. The focus of TCR is original, peer-reviewed, science-based research that successfully advances clinical medicine toward the goal of improving patients'' quality of life. The editors and an international advisory group of scientists and clinician-scientists as well as other experts will hold TCR articles to the high-quality standards. We accept Original Articles as well as Review Articles, Editorials and Brief Articles.