Prognostic Nomogram for Thoracic Esophageal Squamous Cell Carcinoma after Radical Esophagectomy

PLoS One. 2015 Apr 20;10(4):e0124437. doi: 10.1371/journal.pone.0124437. eCollection 2015.

Abstract

Nomogram has demonstrated its capability in individualized estimates of survival in diverse cancers. Here we retrospectively investigated 1195 patients with esophageal squamous-cell carcinoma (ESCC) who underwent radical esophagectomy at Zhejiang Cancer Hospital in Hangzhou, China. We randomly assigned two-thirds of the patients to a training cohort (n = 797) and one-third to a validation cohort (n = 398). Cox proportional hazards regression analyses were performed using the training cohort, and a nomogram was developed for predicting 3-year and 5-year overall survival rates. Multivariate analysis identified tumor length, surgical approach, number of examined lymph node, number of positive lymph node, extent of positive lymph node, grade, and depth of invasion as independent risk factors for survival. The discriminative ability of the nomogram was externally determined using the validation cohort, showing that the nomogram exhibited a sufficient level of discrimination according to the C-index (0.715, 95% CI 0.671-0.759). The C-index of the nomogram was significantly higher than that of the sixth edition (0.664, P-value < 0.0001) and the seventh edition (0.696, P-value < 0.0003) of the TNM classification. This study developed the first nomogram for ESCC, which can be applied in daily clinical practice for individualized survival prediction.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / genetics*
  • China
  • Esophageal Neoplasms / genetics*
  • Esophageal Squamous Cell Carcinoma
  • Esophagectomy / methods*
  • Female
  • Humans
  • Lymph Nodes / pathology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Nomograms*
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Random Allocation
  • Reproducibility of Results
  • Retrospective Studies
  • Thoracic Neoplasms / genetics*

Grants and funding

This study was supported by grants from the National Nature Science Foundation of China (No. 81172081 and No. 31470111), and from the Major Science and Technology Project of Zhejiang Province of China (No. 2011C13039-1).