Construction and evaluation of prognostic models for esophageal cancer patients with distant and non-distant metastases: providing a reference process for clinical diagnosis and treatment

Mingxin Zhang; Manli Cui; Qianqian Zuo; Li Wang; Jia Wang; Lin Zhu; Rong Yan; Ning Lu; Honglin Yan; Lingmin Zhang

doi:10.21037/jgo-21-429

Construction and evaluation of prognostic models for esophageal cancer patients with distant and non-distant metastases: providing a reference process for clinical diagnosis and treatment

J Gastrointest Oncol. 2021 Aug;12(4):1241-1254. doi: 10.21037/jgo-21-429.

Authors

Mingxin Zhang^{1

2}, Manli Cui¹, Qianqian Zuo³, Li Wang⁴, Jia Wang¹, Lin Zhu¹, Rong Yan¹, Ning Lu¹, Honglin Yan¹, Lingmin Zhang⁵

Affiliations

¹ Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China.
² Department of Internal Medicine, The Second Clinical Medical College of Shaanxi University of Chinese Medicine, Xianyang, China.
³ Department of Oncology Geriatrics, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China.
⁴ Department of Scientific Research, The Affiliated Hospital of Xi'an Medical University, Xi'an, China.
⁵ Department of Anesthesiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Abstract

Background: Although the current treatment for esophageal cancer has great technological progress, the 5-year survival rate of patients is not optimistic. About 70% of patients with esophageal cancer are at an advanced stage at first diagnosis. These patients are prone to distant metastasis, and the prognosis is poor. Therefore, understanding the risk factors for distant metastasis in patients with esophageal cancer, combined with the prognosis of the patient, can aid in choosing the optimal diagnosis and treatment plan. Ultimately, it will improve the patient's survival time and quality of life. This research aims to construct a model for the risk assessment of distant metastasis in patients with esophageal cancer and prognostic models for patients with distant and non-distant metastases.

Methods: The Surveillance Epidemiology and End Results (SEER) database was used to select patients with esophageal cancer from 2010 to 2015. The optimal cutoff point was selected for the age and tumor size variables using X-tile. The nomogram was constructed using R software (The R Foundation for Statistical Computing).

Results: Gender, grade, T stage, N stage, and tumor size were independent risk factors associated with distant metastasis in patients with esophageal cancer. The concordance index (C-index) of the nomogram prediction model for whether the patient will have distant metastasis was 0.609. Age, grade, T stage, N stage, and tumor size were independent risk factors affecting the prognosis without distant metastasis. The C-index of the nomogram prediction model for patients with distant metastases was 0.590. Age and T stage were independent risk factors affecting the prognosis of patients with distant metastases. The C-index of the nomogram prediction model was 0.543. The combination of radiotherapy, chemotherapy, and primary surgery yielded the best overall survival for both patients with distant metastases and patients with non-distant metastases.

Conclusions: A comprehensive assessment of the risk of distant metastasis in patients with esophageal cancer, combined with prognosis prediction, is necessary to provide patients with a reasonable treatment plan.

Keywords: Esophageal cancer; distant metastasis; nomogram.