Nomograms for prognostication of outcome in patients with esophageal and gastroesophageal carcinoma undergoing definitive chemoradiotherapy.
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 prognosis are unavailable. We used a number of clinical pre- 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 EGEJC 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
None of the 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 the median RFS duration was 11.6 months (95% CI, 9.43-15.0). After BM therapy, 155 (60.3%) patients achieved a clinical complete response (cCR). In multivariate analyses, maximum initial standardized uptake value 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 cycles of 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 prognostic nomograms of OS and RFS. Upon validation, these nomograms could prove useful in the clinic to individualize therapy.
Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Akihiro
A
Suzuki
Lianchun
L
Xiao
Yuki
Y
Hayashi
Mariela A
MA
Blum
James W
JW
Welsh
Steven H
SH
Lin
Jeffrey H
JH
Lee
Manoop S
MS
Bhutani
Brian
B
Weston
Dipen M
DM
Maru
David C
DC
Rice
Stephen G
SG
Swisher
Wayne L
WL
Hofstetter
Jeremy
J
Erasmus
Jaffer A
JA
Ajani
D000368:Aged; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000628:therapy*; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011379:Prognosis; D016016:Proportional Hazards Models