Model established based on blood markers predicts overall survival in patients after radical resection of types II and III adenocarcinoma of the esophagogastric junction

Abstract

BACKGROUND In recent years, the incidence of types II and III adenocarcinoma of the esophagogastric junction (AEG) has shown an obvious upward trend worldwide. The prognostic prediction after radical resection of AEG has not been well established. AIM To establish a prognostic model for AEG (types II and III) based on routine markers. METHODS A total of 355 patients who underwent curative AEG at The First Affiliated Hospital of Anhui Medical University from January 2014 to June 2015 were retrospectively included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors. A nomogram was constructed based on Cox proportional hazards models. The new score models was analyzed by C index and calibration curves. The receiver operating characteristic (ROC) curve was used to compare the predictive accuracy of the scoring system and tumor-node-metastasis (TNM) stage. Overall survival was calculated using the Kaplan-Meier curve amongst different risk AEG patients. RESULTS Multivariate analysis showed that TNM stage (hazard ratio [HR] = 2.286, P = 0.008), neutrophil-to-lymphocyte ratio (HR = 2.979, P = 0.001), and body mass index (HR = 0.626, P = 0.026) were independent prognostic factors. The new scoring system had a higher concordance index (0.697), and the calibration curves of the nomogram were reliable. The area under the ROC curve of the new score model (3-year: 0.725, 95% confidence interval [CI] : 0.676-0.777; 5-year: 0.758, 95%CI : 0.708-0.807) was larger than that of TNM staging (3-year: 0.630, 95%CI : 0.585-0.684; 5-year: 0.665 , 95%CI : 0.616-0.715). CONCLUSION Based on the serum markers and other clinical indicators, we have developed a precise model to predict the prognosis of patients with AEG (types II and III). The new prognostic nomogram could effectively enhance the predictive value of the TNM staging system. This scoring system can be advantageous and helpful for surgeons and patients.

A novel nomogram based on clinical blood indicators for prognosis prediction in curatively resected esophagogastric junction adenocarcinoma patients

“…Third, the published nomograms by other researchers were mostly aimed at advanced EJA patients who only received chemoradiotherapy 21 , 24 . Indeed, two studies have constructed nomograms using other indicators for EJA patients receiving curative surgery resection with the C-indexes of 0.76 and 0.69 11 , 30 , which were consistent with our results. Importantly, our results could be more solid as we analyzed in a large sample size with validation.…”

“…Increasing numbers of publications showed that some newly-constructed nomograms could provide a more precise prognosis prediction than the traditional cancer TNM system 9 , 10 . Wei et al have constructed a novel nomogram in EJA patients who underwent curative resection containing TNM staging system, body mass index (BMI) and neutrophil-to-lymphocyte ratio (NLR), which showed better discrimination and calibration ability compared with TNM system 11 . However, validation was lacking in their study.…”