title: A nomogram associated with high probability of malignant nodes in the surgical specimen after trimodality therapy of patients with oesophageal cancer.
abstract: BACKGROUND
  The presence of malignant lymph nodes (+ypNodes) in the surgical specimen after preoperative chemoradiation (trimodality) in patients with oesophageal cancer (EC) portends a poor prognosis for overall survival (OS) and disease-free survival (DFS). Currently, none of the clinical variables highly correlates with +ypNodes. We hypothesised that a combination of clinical variables could generate a model that associates with high likelihood of +ypNodes after trimodality in EC patients.
  
  
  METHODS
  We report on 293 consecutive EC patients who received trimodality therapy. A multivariate logistic regression analysis that included pretreatment and post-chemoradiation variables identified independent variables that were used to construct a nomogram for +ypNodes after trimodality in EC patients.
  
  
  RESULTS
  Of 293 patients, 91 (31.1%) had +ypNodes. OS (p=0.0002) and DFS (p<0.0001) were shorter in patients with +ypNodes compared to those with -ypNodes. In multivariable analysis, the significant variables for +ypNodes were: baseline T-stage (odds ratio [OR], 7.145; 95% confidence interval [CI], 1.381-36.969; p=0.019), baseline N-stage (OR, 2.246; 95% CI, 1.024-4.926; p=0.044), tumour length (OR, 1.178; 95% CI, 1.024-1.357; p=0.022), induction chemotherapy (OR, 0.471; 95% CI, 0.242-0.915; p=0.026), nodal uptake on post-chemoradiation positron emission tomography (OR, 2.923; 95% CI, 1.007-8.485; p=0.049) and enlarged node(s) on post-chemoradiation computerised tomography (OR, 3.465; 95% CI, 1.549-7.753; p=0.002). The nomogram after internal validation using the bootstrap method (200 runs) yielded a high concordance index of 0.756.
  
  
  CONCLUSIONS
  Our nomogram highly correlates with the presence of +ypNodes after chemoradiation, however, considerably more refinement is needed before it can be implemented in the clinic.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Lianchun
authors.initials: L
authors.lastname: Xiao
authors.forename: Akihiro
authors.initials: A
authors.lastname: Suzuki
authors.forename: Mariela A
authors.initials: MA
authors.lastname: Blum
authors.forename: Bradley
authors.initials: B
authors.lastname: Sabloff
authors.forename: Takashi
authors.initials: T
authors.lastname: Taketa
authors.forename: Dipen M
authors.initials: DM
authors.lastname: Maru
authors.forename: James
authors.initials: J
authors.lastname: Welsh
authors.forename: Steven H
authors.initials: SH
authors.lastname: Lin
authors.forename: Brian
authors.initials: B
authors.lastname: Weston
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016208:Databases, Factual; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D049451:Nomograms; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D009944:Organoplatinum Compounds; D043823:Taxoids