The Prognostic Significance of Nomogram-Based Pretreatment Inflammatory Indicators in Patients With Esophageal Squamous Cell Carcinoma Receiving Intensity-Modulated Radiotherapy

Zhiyang Xu; Hongqian Ke; Binglin Zheng; Chuyan Lin; Yiping Zhang; Liyan Wang; Yu Lin; Yuling Ye; Lifang Cai; Mengxing You; Junqiang Chen; Yuanji Xu

doi:10.1177/10732748231185025

The Prognostic Significance of Nomogram-Based Pretreatment Inflammatory Indicators in Patients With Esophageal Squamous Cell Carcinoma Receiving Intensity-Modulated Radiotherapy

Cancer Control. 2023 Jan-Dec:30:10732748231185025. doi: 10.1177/10732748231185025.

Authors

Zhiyang Xu¹, Hongqian Ke², Binglin Zheng², Chuyan Lin², Yiping Zhang², Liyan Wang², Yu Lin³, Yuling Ye², Lifang Cai⁴, Mengxing You⁴, Junqiang Chen³, Yuanji Xu³

Affiliations

¹ Department of Thoracic Surgery, The School of Clinical Medicine, Fujian Medical University, The First Hospital of Putian, Putian, China.
² Clinical Oncology School of Fujian Medical University, Fuzhou, China.
³ Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
⁴ Department of Medical Oncology, The School of Clinical Medicine, Fujian Medical University, The First Hospital of Putian, Putian, China.

Abstract

Background: At present, there is no objective prognostic index available for patients with esophageal squamous cell carcinoma (ESCC) who underwent intensity-modulated radiotherapy (IMRT). This study is to develop a nomogram based on hematologic inflammatory indices for ESCC patients treated with IMRT.

Methods: 581 patients with ESCC receiving definitive IMRT were enrolled in our retrospective study. Of which, 434 patients with treatment-naïve ESCC in Fujian Cancer Hospital were defined as the training cohort. Additional 147 newly diagnosed ESCC patients were used as the validation cohort. Independent predictors of overall survival (OS) were employed to establish a nomogram model. The predictive ability was evaluated by time-dependent receiver operating characteristic curves, the concordance index (C-index), net reclassification index (NRI), and integrated discrimination improvement (IDI). Decision curve analysis (DCA) was performed to assess the clinical benefits of the nomogram model. The entire series was divided into 3 risk subgroups stratified by the total nomogram scores.

Results: Clinical TNM staging, primary gross tumor volume, chemotherapy, neutrophil-to-lymphocyte ratio and platelet lymphocyte ratio were independent predictors of OS. Nomogram was developed incorporating these factors. Compared with the 8th American Joint Committee on Cancer (AJCC) staging, the C-index for 5-year OS (.627 and .629) and the AUC value of 5-year OS (.706 and .719) in the training and validation cohorts (respectively) were superior. Furthermore, the nomogram model presented higher NRI and IDI. DCA also demonstrated that the nomogram model provided greater clinical benefit. Finally, patients with <84.8, 84.8-151.4, and >151.4 points were categorized into low-risk, intermediate-risk, and high-risk groups. Their 5-year OS rates were 44.0%, 23.6%, and 8.9%, respectively. The C-index was .625, which was higher than the 8^th AJCC staging.

Conclusions: We have developed a nomogram model that enables risk-stratification of patients with ESCC receiving definitive IMRT. Our findings may serve as a reference for personalized treatment.

Keywords: esophageal squamous cell carcinoma; intensity-modulated radiotherapy; nomogram; prognosis; risk-stratification.

MeSH terms

Esophageal Neoplasms*
Esophageal Squamous Cell Carcinoma* / radiotherapy
Humans
Nomograms
Prognosis
Radiotherapy, Intensity-Modulated*
Retrospective Studies