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食管鳞状细胞癌患者根治术后生存预测模型的建立与验证:一项多中心真实世界队列研究

杨文蕾 刘芳芳 徐瑞平 杨伟 何煜 刘震 周福有 衡反修 侯波林 张立新 陈蕾 张凡 蔡奋 许铧文 林妙萍 刘萌飞 潘雅琪 刘英 胡喆 陈环宇 何忠虎 柯杨

杨文蕾, 刘芳芳, 徐瑞平, 杨伟, 何煜, 刘震, 周福有, 衡反修, 侯波林, 张立新, 陈蕾, 张凡, 蔡奋, 许铧文, 林妙萍, 刘萌飞, 潘雅琪, 刘英, 胡喆, 陈环宇, 何忠虎, 柯杨. 食管鳞状细胞癌患者根治术后生存预测模型的建立与验证:一项多中心真实世界队列研究[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2022-0496
引用本文: 杨文蕾, 刘芳芳, 徐瑞平, 杨伟, 何煜, 刘震, 周福有, 衡反修, 侯波林, 张立新, 陈蕾, 张凡, 蔡奋, 许铧文, 林妙萍, 刘萌飞, 潘雅琪, 刘英, 胡喆, 陈环宇, 何忠虎, 柯杨. 食管鳞状细胞癌患者根治术后生存预测模型的建立与验证:一项多中心真实世界队列研究[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2022-0496
YANG Wenlei, LIU Fangfang, XU Ruiping, YANG Wei, HE Yu, LIU Zhen, ZHOU Fuyou, HENG Fanxiu, HOU Bolin, ZHANG Lixin, CHEN Lei, ZHANG Fan, CAI Fen, XU Huawen, LIN Miaoping, LIU Mengfei, PAN Yaqi, LIU Ying, HU Zhe, CHEN Huanyu, HE Zhonghu, KE Yang. Development and Validation of a Prognosis Prediction Model for Esophageal Squamous Cell Carcinoma Patients Treated with Esophagectomy: A Multicenter Real-world Clinical Study[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2022-0496
Citation: YANG Wenlei, LIU Fangfang, XU Ruiping, YANG Wei, HE Yu, LIU Zhen, ZHOU Fuyou, HENG Fanxiu, HOU Bolin, ZHANG Lixin, CHEN Lei, ZHANG Fan, CAI Fen, XU Huawen, LIN Miaoping, LIU Mengfei, PAN Yaqi, LIU Ying, HU Zhe, CHEN Huanyu, HE Zhonghu, KE Yang. Development and Validation of a Prognosis Prediction Model for Esophageal Squamous Cell Carcinoma Patients Treated with Esophagectomy: A Multicenter Real-world Clinical Study[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2022-0496

食管鳞状细胞癌患者根治术后生存预测模型的建立与验证:一项多中心真实世界队列研究

doi: 10.12290/xhyxzz.2022-0496
基金项目: 

国家自然科学基金( 82073626); 国家科技基础资源调查专项( 2019FY101102)

详细信息
    通讯作者:

    何忠虎, E-mail:zhonghuhe@foxmail.com

    柯杨, E-mail:keyang@bjmu.edu.cn

  • 中图分类号: R735.1;R181.2

Development and Validation of a Prognosis Prediction Model for Esophageal Squamous Cell Carcinoma Patients Treated with Esophagectomy: A Multicenter Real-world Clinical Study

Funds: 

National Natural Science Foundation of China (82073626); National Science & Technology Fundamental Resources Investigation Program of China (2019FY101102)

  • 摘要: 目的 建立并验证食管鳞状细胞癌患者根治术后生存预后预测模型与风险分级标准,为术后最优辅助治疗方案的确定提供真实世界证据。 方法 分别收集2011年5月31日至2018年7月31日在河南省安阳市肿瘤医院(安阳中心)和2009年8月1日至2018年12月31日在广东省汕头大学医学院附属肿瘤医院(汕头中心)连续就诊的食管癌患者的临床数据和生存随访数据。以安阳中心数据集为建模集,采用基于多因素Cox比例风险回归逐步后退法和AIC准则( Akaike information criterion)的“两步法”构建总生存预测模型。通过Bootstrap重抽样1 000次对模型进行内部统计验证,在汕头中心数据集进行外部验证。根据列线图得分构建预后风险分级标准。 结果 建模队列和验证队列分别纳入4 171例和1 895例食管鳞状细胞癌患者。模型由年龄、性别、肿瘤原发位置、T分期、N分期、淋巴结清扫数、肿瘤大小、辅助治疗方案和术前血红蛋白水平9个变量组成。其中,N分期与辅助治疗方案存在显著交互作用( P <0.001),即与单纯手术相比,N+期患者可能从辅助治疗中获益,但辅助治疗无法改善N0期患者的预后。建模队列的模型一致性指数( C-index)为0.728(95% CI:0.713~0.742),经Bootstrap内部验证后为0.722(95% CI:0.711~0.739),汕头验证队列的模型C-index为0.679(95% CI:0.662~0.697)。校准图提示模型预测生存率与观测生存率一致性良好。在两个队列中模型准确性均显著高于第7版AJCC ( American Joint Committeeon Cancer) TNM分期系统( P < 0.05)。此外,在各TNM分期内部,该模型仍可实现理想的预后风险分层效果。 结论 本研究为我国食管鳞状细胞癌患者根治术后总生存提供了个体化预测模型,并揭示N分期可能是制订食管鳞状细胞癌患者术后辅助治疗方案的重要决定因素。
  • [1] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71: 209-249.
    [2] Liang H, Fan JH, Qiao YL. Epidemiology, etiology, and prevention of esophageal squamous cell carcinoma in China[J]. Cancer Biol Med, 2017, 14: 33-41.
    [3] Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14(CONCORD-3): analysis of individual records for 37513025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries[J]. Lancet, 2018, 391: 1023-1075.
    [4] Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022[J]. CA Cancer J Clin, 2022, 72: 7-33.
    [5] Van Putten M, De Vos-Geelen J, Nieuwenhuijzen GaP, et al. Long-term survival improvement in oesophageal cancer in the Netherlands[J]. Eur J Cancer, 2018, 94: 138-147.
    [6] Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries[J]. The Lancet. Global health, 2018, 6: e555-e567.
    [7] Rice TW, Rusch VW, Apperson-Hansen C, et al. Worldwide esophageal cancer collaboration[J]. Dis Esophagus, 2009, 22: 1-8.
    [8] Watanabe M, Tachimori Y, Oyama T, et al. Comprehensive registry of esophageal cancer in Japan, 2013[J]. Esophagus, 2021, 18: 1-24.
    [9] Mao YS, Gao SG, Wang Q, et al. [Epidemiological characteristic and current status of surgical treatment for esophageal cancer by analysis of national registry database][J]. Zhonghua Zhong Liu Za Zhi, 2020, 42: 228-233.
    [10] Yang HX, Ling L, Zhang X, et al. Outcome of elderly patients with oesophageal squamous cell carcinoma after surgery[J]. Br J Surg, 2010, 97: 862-867.
    [11] Bohanes P, Yang D, Chhibar RS, et al. Influence of sex on the survival of patients with esophageal cancer[J]. J Clin Oncol, 2012, 30: 2265-2272.
    [12] He Y, Liang D, Du L, et al. Clinical characteristics and survival of 5283 esophageal cancer patients: A multicenter study from eighteen hospitals across six regions in China[J]. Cancer Commun (Lond), 2020, 40: 531-544.
    [13] Wang BY, Goan YG, Hsu PK, et al. Tumor length as a prognostic factor in esophageal squamous cell carcinoma[J]. Ann Thorac Surg, 2011, 91: 887-893.
    [14] Smyth EC, Lagergren J, Fitzgerald RC, et al. Oesophageal cancer[J]. Nat Rev Dis Primers, 2017, 3: 17048.
    [15] Miyata H, Yamasaki M, Kurokawa Y, et al. Prognostic value of an inflammation-based score in patients undergoing pre-operative chemotherapy followed by surgery for esophageal cancer[J]. Exp Ther Med, 2011, 2: 879-885.
    [16] Su D, Zhou X, Chen Q, et al. Prognostic Nomogram for Thoracic Esophageal Squamous Cell Carcinoma after Radical Esophagectomy[J]. PLoS One, 2015, 10: e0124437.
    [17] Shao Y, Ning Z, Chen J, et al. Prognostic nomogram integrated systemic inflammation score for patients with esophageal squamous cell carcinoma undergoing radical esophagectomy[J]. Sci Rep, 2015, 5: 18811.
    [18] Chen GP, Huang Y, Yang X, et al. A Nomogram to Predict Prognostic Value of Red Cell Distribution Width in Patients with Esophageal Cancer[J]. Mediators Inflamm, 2015, 2015: 854670.
    [19] Liu JS, Huang Y, Yang X, et al. A nomogram to predict prognostic values of various inflammatory biomarkers in patients with esophageal squamous cell carcinoma[J]. Am J Cancer Res, 2015, 5: 2180-2189.
    [20] Yu S, Zhang W, Ni W, et al. Nomogram and recursive partitioning analysis to predict overall survival in patients with stage IIB-III thoracic esophageal squamous cell carcinoma after esophagectomy[J]. Oncotarget, 2016, 7: 55211- 55221.
    [21] Duan J, Deng T, Ying G, et al. Prognostic nomogram for previously untreated patients with esophageal squamous cell carcinoma after esophagectomy followed by adjuvant chemotherapy[J]. Jpn J Clin Oncol, 2016, 46: 336-343.
    [22] Chen S, Yang X, Feng JF. A novel inflammation-based prognostic score for patients with esophageal squamous cell carcinoma: the c-reactive protein/prognostic nutritional index ratio[J]. Oncotarget, 2016, 7: 62123-62132.
    [23] Deng W, Wang Q, Xiao Z, et al. A prognostic nomogram for overall survival after neoadjuvant radiotherapy or chemoradiotherapy in thoracic esophageal squamous cell carcinoma: a retrospective analysis[J]. Oncotarget, 2017, 8: 41102-41112.
    [24] Deng W, Zhang W, Yang J, et al. Nomogram to Predict Overall Survival for Thoracic Esophageal Squamous Cell Carcinoma Patients After Radical Esophagectomy[J]. Ann Surg Oncol, 2019, 26: 2890-2898.
    [25] Li X, Xu J, Zhu L, et al. A novel nomogram with preferable capability in predicting the overall survival of patients after radical esophageal cancer resection based on accessible clinical indicators: A comparison with AJCC staging[J]. Cancer Med, 2021, 10: 4228-4239.
    [26] Shao CY, Liu XL, Yao S, et al. Development and validation of a new clinical staging system to predict survival for esophageal squamous cell carcinoma patients: Application of the nomogram[J]. Eur J Surg Oncol, 2021, 47: 1473- 1480.
    [27] Jung HA, Adenis A, Lee J, et al. Nomogram to predict treatment outcome of fluoropyrimidine/platinum-based chemotherapy in metastatic esophageal squamous cell carcinoma[J]. Cancer Res Treat, 2013, 45: 285-294.
    [28] Wang J, Wu LL, Zhang Y, et al. Establishing a survival prediction model for esophageal squamous cell carcinoma based on CT and histopathological images[J]. Phys Med Biol, 2021, 66.
    [29] Zhao P, Yan W, Fu H, et al. Efficacy of postoperative adjuvant chemotherapy for esophageal squamous cell carcinoma: A meta-analysis[J]. Thorac Cancer, 2018, 9: 1048-1055.
    [30] Lin HN, Chen LQ, Shang QX, et al. A meta-analysis on surgery with or without postoperative radiotherapy to treat squamous cell esophageal carcinoma[J]. Int J Surg, 2020, 80: 184-191.
    [31] Kang J, Chang JY, Sun X, et al. Role of Postoperative Concurrent Chemoradiotherapy for Esophageal Carcinoma: A meta-analysis of 2165 Patients[J]. J Cancer, 2018, 9: 584-593.
    [32] National Comprehensive Cancer Network. Esophageal and Esophagogastric Junction Cancers. Version 4.2021 August 03, 2021[EB/OL] [January 14, 2022]. https://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf.
    [33] Noh SH, Park SR, Yang HK, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an openlabel, randomised phase 3 trial[J]. Lancet Oncol, 2014, 15: 1389-1396.
    [34] Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOGdirected intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection[J]. J Clin Oncol, 2012, 30: 2327-2333.
    [35] Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction[J]. Ann Surg Oncol, 2010, 17: 1721-1724.
    [36] Harrell Jr FE, Harrell Jr MFE. Package ‘hmisc’[J]. CRAN2018, 2019, 2019: 235-236.
    [37] Wang Y, Li J, Xia Y, et al. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy[J]. J Clin Oncol, 2013, 31: 1188- 1195.
    [38] Tian H, Yang W, Hu Y, et al. Estimating cancer incidence based on claims data from medical insurance systems in two areas lacking cancer registries in China[J]. EClinicalMedicine, 2020, 20: 100312.
    [39] He Z, Ke Y. Precision screening for esophageal squamous cell carcinoma in China[J]. Chin J Cancer Res, 2020, 32: 673-682.
    [40] Yuequan J, Shifeng C, Bing Z. Prognostic factors and family history for survival of esophageal squamous cell carcinoma patients after surgery[J]. Ann Thorac Surg, 2010, 90: 908-913.
    [41] Visser E, Markar SR, Ruurda JP, et al. Prognostic Value of Lymph Node Yield on Overall Survival in Esophageal Cancer Patients: A Systematic Review and Meta-analysis[J]. Ann Surg, 2019, 269: 261-268.
    [42] Anandavadivelan P, Lagergren P. Cachexia in patients with oesophageal cancer[J]. Nat Rev Clin Oncol, 2016, 13: 185-198.
    [43] Huang XZ, Yang YC, Chen Y, et al. Preoperative Anemia or Low Hemoglobin Predicts Poor Prognosis in Gastric Cancer Patients: A Meta-Analysis[J]. Dis Markers, 2019, 2019: 7606128.
    [44] Lu Z, Fang Y, Liu C, et al. Early Interdisciplinary Supportive Care in Patients With Previously Untreated Metastatic Esophagogastric Cancer: A Phase III Randomized Controlled Trial[J]. J Clin Oncol, 2021, 39: 748-756.
    [45] Zhang SS, Yang H, Xie X, et al. Adjuvant chemotherapy versus surgery alone for esophageal squamous cell carcinoma: a meta-analysis of randomized controlled trials and nonrandomized studies[J]. Dis Esophagus, 2014, 27: 574- 584.
    [46] Ni W, Yu S, Zhang W, et al. A phase-II/III randomized controlled trial of adjuvant radiotherapy or concurrent chemoradiotherapy after surgery versus surgery alone in patients with stage-IIB/III esophageal squamous cell carcinoma[J]. BMC Cancer, 2020, 20: 130.
    [47] Rucker AJ, Raman V, Jawitz OK, et al. The Impact of Adjuvant Therapy on Survival After Esophagectomy for Node-negative Esophageal Adenocarcinoma[J]. Ann Surg, 2022, 275: 348-355.
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出版历程
  • 收稿日期:  2022-09-02
  • 修回日期:  2022-10-13
  • 网络出版日期:  2022-11-30

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