Abstract:
Objective To develop a nomogram to predict prognosis in patients with esophageal squamous cell carcinoma (ESCC) and guide individualized treatment.
Methods From January 2002 to December 2016, a total of 2,680 patients with ESCC recruited from 10 national radiotherapy center (3JECROG R-03A) treated with definitive radiotherapy were randomly assigned into a training group and a validation group. A nomogram was built based on prognostic factors associated with the training group and validated using external and internal cohorts. Prognosis and clinical benefits were compared between the nomogram and the AJCC/UICC staging. Results: The respective 1-, 3-, and 5-year overall survival (OS) rates of the whole cohort were 69.0%, 37.7%, and 31.0%. Tumor location, TNM stage, primary tumor volume, and concurrent chemoradiotherapy were found to be independent prognostic factors by multivariate analyses (all P<0.05). Nomogram C-indices and AUC values in the training and validation groups were all significantly higher than those obtained from AJCC/UICC staging. Low, medium, and high risk groups were identified using training nomogram scores. Compared with those obtained by AJCC/UICC staging, the OS curves were separated better, and the areas under the 1-, 3-, and 5-decision curve analysis (DCA) curves were larger when using the nomogram.
Conclusions In comparison to AJCC/UICC staging, the nomogram more accurately predicted prognosis, contributing to improved prognostic prediction and personalized treatment.