Prediction of survival in patients with oesophageal or junctional cancer receiving neoadjuvant chemoradiotherapy and surgery.
BACKGROUND
The value of conventional prognostic factors is unclear in the era of multimodal treatment for oesophageal cancer. This study aimed to quantify the impact of neoadjuvant chemoradiotherapy (nCRT) and surgery on well established prognostic factors, and to develop and validate a prognostic model.


METHODS
Patients treated with nCRT plus surgery were included. Multivariable Cox modelling was used to identify prognostic factors for overall survival. A prediction model for individual survival was developed using stepwise backward selection. The model was internally validated leading to a nomogram for use in clinical practice.


RESULTS
Some 626 patients who underwent nCRT plus surgery were included. In the multivariable model, only pretreatment cN category and ypN category were independent prognostic factors. The final prognostic model included cN, ypT and ypN categories, and had moderate discrimination (c-index at internal validation 0·63).


CONCLUSIONS
In patients with oesophageal or oesophagogastric cancer treated with nCRT plus surgery, overall survival can best be estimated using a prediction model based on cN, ypT and ypN categories. Predicted survival according to this model showed only moderate correlation with observed survival, emphasizing the need for new prognostic factors to improve survival prediction.
Departments of Surgery, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.
J
J
Shapiro
Departments of Public Health, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.
D
D
van Klaveren
Departments of Surgery, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.|Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
S M
SM
Lagarde
Departments of Surgery, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.
E L A
EL
Toxopeus
Departments of Medical Oncology, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.
A
A
van der Gaast
Departments of Radiotherapy, Academic Medical Centre, Amsterdam, The Netherlands.
M C C M
MC
Hulshof
Departments of Surgery, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.
B P L
BP
Wijnhoven
Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
M I
MI
van Berge Henegouwen
Departments of Public Health, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.
E W
EW
Steyerberg
Departments of Surgery, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.
J J B
JJ
van Lanschot
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009426:Netherlands / Q000453:epidemiology; D049451:Nomograms; D011379:Prognosis