Development and validation of a nomogram prognostic model for esophageal cancer patients with oligometastases

Butuo Li,Wanlong Li,Jinming Yu,Peng Xie,Xindong Sun,Xiubin Sun,Ting Zhang,Linlin Wang,Xue Meng,Chao Jiang,Ruiqing Wang,Bing Zou

doi:10.1038/s41598-020-68160-6

Abstract

Platinum-based chemotherapy is recommended as the standard treatment for metastatic esophageal cancer (EC) patients; however, the outcome is poor. Oligometastasis is less aggressive and has limited growth potential. However, the prognostic factors for EC patients with oligometastases was largely unknown. Thus, we intend to determine the prognostic factors, and develop and validate nomograms for prediction of survival for EC patients with oligometastases. In this study, characteristics of 273 oligometastatic EC patients were analyzed using univariate and multivariate Cox models to determine the independent prognostic factors for progression-free survival (PFS) and overall survival (OS). The result showed that history of alcohol consumption, longer tumor, no local radiotherapy for EC, and no local treatment for metastases were independent factors for PFS. Sex, esophageal fistula, number of metastatic organs, and local radiotherapy for EC were independent prognostic factors for OS. On the basis of Cox models, the respective nomogram for prediction of PFS and OS was established with the corrected concordance index of 0.739 and 0.696 after internal cross-validation. In conclusion, local treatment for metastases and local radiotherapy for EC were demonstrated to be beneficial for oligometastatic EC patients, and the validated nomograms are valuable in prognosis prediction and could guide individualized management for these patients.

Highlights

Platinum-based chemotherapy is recommended as the standard treatment for metastatic esophageal cancer (EC) patients; the outcome is poor
Among 576 patients with metastatic EC, 273 (47.4%) of them had oligometastases and 303 (52.6%) patients had polymetastatic EC. 273 oligometastatic EC patients were enrolled in this study, and 152 patients died and 229 patients developed disease progression within a median follow-up of 14.2 mo
In terms of tumor characteristics, most of the tumors were located in the thoracic esophagus and 91.2% was squamous cell cancer

Summary

Introduction

Platinum-based chemotherapy is recommended as the standard treatment for metastatic esophageal cancer (EC) patients; the outcome is poor. We intend to determine the prognostic factors, and develop and validate nomograms for prediction of survival for EC patients with oligometastases. Platinumbased chemotherapy is recommended as the standard treatment for metastatic EC patients; the outcome is poor with a response of 20–50%2 and 5-year survival < 5%3. It is necessary for the risk assessment of disease progression and death, which may result in individualized therapies and improvement of patient survival. Prognostic factors for metastatic EC patients have been investigated, and better performance, limited metastases, and aggressive primary tumor radiotherapy were found. A nomogram based on the clinical factors and treatment strategies may be promising in the quantitative evaluation of survival in EC patients with oligometastases

Methods

Results

Conclusion