Increases prognostic value of clinical-pathological nomogram in patients with esophageal squamous cell carcinoma

Jing Feng Hu; Xin Song; Kan Zhong; Xue Ke Zhao; Fu You Zhou; Rui Hua Xu; Ji Lin Li; Xian Zeng Wang; Xue Min Li; Pan Pan Wang; Ling Ling Lei; Meng Xia Wei; Ran Wang; Zong Min Fan; Xue Na Han; Yao Chen; Liu Yu Li; Jia Jia Ji; Yuan Ze Yang; Bei Li; Miao Miao Yang; Hai Jun Yang; Fu Bao Chang; Jing Li Ren; Sheng Li Zhou; Li Dong Wang

doi:10.3389/fonc.2023.997776

Increases prognostic value of clinical-pathological nomogram in patients with esophageal squamous cell carcinoma

Front Oncol. 2023 Feb 14:13:997776. doi: 10.3389/fonc.2023.997776. eCollection 2023.

Authors

Jing Feng Hu^{1

2}, Xin Song^{1

2}, Kan Zhong^{1

2}, Xue Ke Zhao^{1

2}, Fu You Zhou³, Rui Hua Xu^{1

2}, Ji Lin Li⁴, Xian Zeng Wang⁵, Xue Min Li⁶, Pan Pan Wang^{1

2}, Ling Ling Lei^{1

2}, Meng Xia Wei^{1

2}, Ran Wang^{1

2}, Zong Min Fan^{1

2}, Xue Na Han^{1

2}, Yao Chen^{1

2}, Liu Yu Li^{1

2}, Jia Jia Ji^{1

2}, Yuan Ze Yang^{1

2}, Bei Li^{1

2}, Miao Miao Yang^{1

2}, Hai Jun Yang³, Fu Bao Chang⁷, Jing Li Ren⁸, Sheng Li Zhou⁹, Li Dong Wang^{1

2}

Affiliations

¹ State Key Laboratory of Esophageal Cancer Prevention & Treatment of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China.
² Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China.
³ Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang, Henan, China.
⁴ Department of Pathology, Linzhou Esophageal Cancer Hospital, Linzhou, Henan, China.
⁵ Department of Thoracic Surgery, Linzhou People's Hospital, Linzhou, Henan, China.
⁶ Department of Pathology, Hebei Provincial Cixian People's Hospital, Cixian, Hebei, China.
⁷ Department of Surgery, Central Hospital of Linzhou City, Linzhou, Henan, China.
⁸ Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
⁹ Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, Henan, China.

Abstract

Background: This study was intended to construct a brand new prognostic nomogram after combine clinical and pathological characteristics to increases prognostic value in patients with esophageal squamous cell carcinoma.

Methods: A total of 1,634 patients were included. Subsequently, the tumor tissues of all patients were prepared into tissue microarrays. AIPATHWELL software was employed to explore tissue microarrays and calculate the tumor-stroma ratio. X-tile was adopted to find the optimal cut-off value. Univariate and multivariate Cox analyses were used to screen out remarkable characteristics for constructing the nomogram in the total populations. A novel prognostic nomogram with clinical and pathological characteristics was constructed on the basis of the training cohort (n=1,144). What's more performance was validated in the validation cohort (n=490). Clinical-pathological nomogram were assessed by concordance index, time-dependent receiver operating characteristic, calibration curve and decision curve analysis.

Results: The patients can divide into two groups with cut-off value of 69.78 for the tumor-stroma ratio. It is noteworthy that the survival difference was noticeable (P<0.001). A clinical-pathological nomogram was constructed by combining clinical and pathological characteristics to predict the overall survival. In comparison with TNM stage, the concordance index and time-dependent receiver operating characteristic of the clinical-pathological nomogram showed better predictive value (P<0.001). High quality of calibration plots in overall survival was noticed. As demonstrated by the decision curve analysis, the nomogram has better value than the TNM stage.

Conclusions: As evidently revealed by the research findings, tumor-stroma ratio is an independent prognostic factor in patients with esophageal squamous cell carcinoma. The clinical-pathological nomogram has an incremental value compared TNM stage in predicting overall survival.

Keywords: esophageal squamous cell carcinoma; nomogram; overall survival; prognosis; tumor-stroma ratio.

Grants and funding

This work was supported by the National Natural Science Foundation of China (No. 81872032 and No. Ul804262).