Construction and validation of a nomogram model to predict the overall survival rate of esophageal cancer patients receiving neoadjuvant chemotherapy: A population-based study

Abstract

IntroductionThe development of neoadjuvant chemotherapy(nCT) improves the overall survival (OS) of patients with esophageal cancer(EC). The aim of this study was to determine the independent prognostic factors of EC patients receiving nCT, and to construct a nomogram model for predicting OS.MethodThis retrospective analysis was conducted from the National Cancer Institute's Surveillance Epidemiology and End Results, Clinicopathological data of patients with EC who received nCT from 2004 to 2015. The included patients were randomly divided into the training cohort and the validation cohort. Univariate and multivariate Cox proportional hazards models were used to analyze the patients in the training cohort to determine the independent prognostic factors. Based on the independent prognostic variables, nomogram models for 1-year, 2-year and 3-year OS were constructed. The receiver operating characteristic (ROC) and area under curve (AUC) were used to evaluate the discriminative ability. The calibration curves, decision curve analysis (DCA) and Kaplan-Meier (K-M) survival analysis were used to evaluate the predictive accuracy and clinical application value.ResultsA total of 2,493 patients were enrolled, with 1,748 patients in the training cohort and 745 patients in the validation cohort. Gender, marital status, tumor pathological grade, T stage, N stage, and M stage were identified as independent prognostic factor (P < 0.05). A novel nomogram model was constructed. ROC curve analysis revealed that the model had moderate predictive performance, which was better than that of the AJCC TNM staging system.The calibration curves showed a high agreement between the actual observed values and the predicted values. The DCA suggested that the newly constructed prediction model had good clinical application value. K-M survival analysis showed that the model was helpful to accurately distinguish the prognosis of patients with different risk levels.ConclusionsGender, tumor pathological grade, marital status, T stage, N stage and M stage were identified as independent prognostic factors for overall survival of patients with esophageal cancer who received neoadjuvant chemotherapy. A nomogram prediction model was established, which was helpful to accurately and reliably predict the overall survival rate of patients with esophageal cancer who received neoadjuvant chemotherapy at 1, 2 and 3 years.

Enhanced antitumour immunity following neoadjuvant chemoradiotherapy mediates a favourable prognosis in women with resected pancreatic cancer

“…These findings collectively provide compelling evidence that differences in gemcitabine-based nCRT sensitivity predominantly drive the survival disparities between the sexes. Consistent with our results, several studies have reported improved survival outcomes in women with various cancers, including PDAC treated with (neoadjuvant) chemotherapy [24][25][26][27] or nCRT. 28 29 Our comprehensive immune profiling analysis revealed reduced immune suppression as a potential mechanistic basis for the increased efficacy of gemcitabine-based nCRT in PDAC Figure 4 Survival and data exploration analysis in resected PDAC patients included in the transcriptomic Nanostring analysis (A) Kaplan-Meier curves and univariate Cox regression models, stratified by treatment, illustrating the preservation of the significantly prolonged OS in women with resected PDAC who received nCRT compared with men in this patient subset.…”

“…[20][21][22][23] Multiple studies have consistently reported better response rates and prolonged survival among women undergoing anticancer treatments, including nCRT. [24][25][26][27][28][29] Inititally, these beneficial outcomes were ascribed to reduced exposure to risk factors or enhanced pharmacokinetic drug handling. However, accumulating evidence underscores the role of sex-dependent immunity.…”