A novel nomogram for predicting long-term survival in patients with esophageal squamous cell carcinoma after minimally invasive esophagectomy

Abstract

Background

Esophageal cancer is the 7th most common cancer worldwide, while esophageal squamous cell carcinoma (ESCC) is the 4th leading cause of cancer-related deaths in China. Minimally invasive esophagectomy (MIE) is the employed as the primary treatment for ESCC. However, there is still a lack of specialized tools for evaluating postoperative outcomes in these patients.

Methods

Univariate and multivariate COX regression analyses were conducted to identify the prognostic factors. A nomogram was developed for predicting the survival probabilities at 1-, 3- and 5- year after MIE. The prediction performance of the developed nomogram was evaluated using the receiver operating characteristic (ROC) curve, concordance index (C-index), calibration curve, decision curve analysis (DCA) curve and risk stratification.

Results

A total of 709 patients were enrolled in the study. Age, vascular invasion, pT stage and pN stage were independent predictors of the prognosis and were used to develop a nomogram model. The areas under the curve (AUC) values predicting overall survival (OS) at 1, 3 and 5 years were 0.814, 0.761 and 0.794 in the training cohort and 0.703, 0.751 and 0.780 in the validation cohort. Furthermore, the calibration plot revealed good agreement between the predicted results and actual observations. The DCA curve confirmed that the nomogram achieved higher clinical value compared to other indicators. Further, we stratified the entire patient population into low-risk group, medium risk group and high-risk group. A significant difference in survival was observed between the three groups (P < 0.001)

Conclusions

A novel nomogram for predicting ESCC patient's survival outcomes after MIE. The accuracy of the proposed nomogram exceeded that of the Union for Union for International Cancer Control(UICC)/American Joint Committee on Cancer(AJCC) 8th staging systems.