Nomograms for prognostication of patients with esophageal and gastroesophageal carcinoma undergoing definitive chemoradiotherapy.

Abstract

82 Background: Level-1 evidence for definitive chemoradiotherapy (bimodality therapy or BM therapy) has been established for patients with esophageal and gastroesophageal junction cancers (EGEJC) who otherwise do not qualify for surgery; however, tools to estimate individual patient’s prognosis are unavailable. We used a number of clinical pre-treatment and post-treatment parameters to establish two nomograms (for overall survival [OS] and relapse-free survival [RFS]). Methods: From 2002 through 2010, 257 consecutive patients with EGJEC who received BM therapy and had pre- and post-treatment positron emission tomography (PET) and post-treatment endoscopic biopsies among other assessments were analyzed from a prospectively maintained database. Standard statistical methods were used to generate the nomograms. Results: The median follow -up time was 39.2 months (95% confidence interval [CI], 35.7 – 50.1). None of 257 patients underwent surgery. Persistent or recurrent cancer was documented in 187 (72.8%) patients. The estimated median survival duration for all 257 patients was 21.1 months (95% CI, 18.9-27.1) and median RFS duration was 11.6 months (95% CI, 9.43-15.0). The estimated OS and RFS rates at 3 years were 37.3% (95% CI, 31.2%-44.7%) and 25.1% (95% CI, 19.9%-31.6%), respectively. After BM therapy, 155 (60.3%) patients achieved a clinical complete response (cCR). In the multivariate analyses, initial standardized uptake value maximum and cCR were independent prognostic variables for OS (P=0.038, P<0.001). Nomogram concordance indices of 0.70 for OS and 0.77 for RFS were established by 200 bootstrap resampling for each of the two outcomes. Conclusions: Our data suggest that in patients with EGEJC, pre- and post-treatment clinical parameters contribute to the establishment of OS and RFS prognostic nomograms. Upon validated, these nomograms could prove useful in the clinic to individualize therapy.