title: A Nomogram to Predict Distant Metastases After Multimodality Therapy for Patients With Localized Esophageal Cancer.
abstract: Among patients with localized esophageal cancer (LEC), 35% or more develop distant metastases (DM) as first relapse, most in the first 24 months after local therapy. Implementation of novel strategies may be possible if DM can be predicted reliably. We hypothesized that clinical variables could help generate a DM nomogram.
  
  
  
  Patients with LEC who completed multimodality therapy were analyzed. Various statistical methods were used, including multivariate analysis to generate a nomogram. A concordance index (c-index) was established and validated using the bootstrap method.
  
  
  
  Among 629 patients analyzed (356 trimodality/273 bimodality), 36% patients developed DM as first relapse. The median overall survival from DM was only 8.6 months (95% CI, 7.0-10.2). In a multivariate analysis, the variables associated with a higher risk for developing DM were poorly differentiated histology (hazard ratio [HR], 1.76; P<.0001), baseline T3/T4 primary (HR, 3.07; P=.0006), and baseline N+ LEC (HR, 2.01; P<.0001). Although variables associated with a lower risk for DM were age of 60 years or older (HR, 0.75; P=.04), squamous cell carcinoma (HR, 0.54; P=.013), and trimodality therapy (HR, 0.58; P=.0001), the bias-corrected c-index was 0.67 after 250 bootstrap resamples.
  
  
  
  Our nomogram identified patients with LEC who developed DM with a high probability. The model needs to be refined (tumor and blood biomarkers) and validated. This type of model will allow implementation of novel strategies in patients with LEC.
authors: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Kazuki
authors: K
authors: Sudo
authors: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Xuemei
authors: X
authors: Wang
authors: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Lianchun
authors: L
authors: Xiao
authors: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Roopma
authors: R
authors: Wadhwa
authors: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Hironori
authors: H
authors: Shiozaki
authors: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Elena
authors: E
authors: Elimova
authors: Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: David C
authors: DC
authors: Rice
authors: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Jeffrey H
authors: JH
authors: Lee
authors: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Brian
authors: B
authors: Weston
authors: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Manoop S
authors: MS
authors: Bhutani
authors: Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Adarsh
authors: A
authors: Hiremath
authors: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Nikolaos
authors: N
authors: Charalampakis
authors: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Ritsuko
authors: R
authors: Komaki
authors: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Mariela A
authors: MA
authors: Blum
authors: Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Stephen G
authors: SG
authors: Swisher
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Dipen M
authors: DM
authors: Maru
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Heath D
authors: HD
authors: Skinner
authors: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Jeana L
authors: JL
authors: Garris
authors: Department of The University of Pharmacy Clinical Programs, Texas MD Anderson Cancer Center, Houston, Texas
authors: Jane E
authors: JE
authors: Rogers
authors: Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Wayne L
authors: WL
authors: Hofstetter
authors: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
authors: Jaffer A
authors: JA
authors: Ajani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000379:methods; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis* / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D049451:Nomograms; D055815:Young Adult