TY - JOUR
T1 - A nomogram associated with high probability of malignant nodes in the surgical specimen after trimodality therapy of patients with oesophageal cancer
AU - Hayashi, Yuki
AU - Xiao, Lianchun
AU - Suzuki, Akihiro
AU - Blum, Mariela A.
AU - Sabloff, Bradley
AU - Taketa, Takashi
AU - Maru, Dipen M.
AU - Welsh, James
AU - Lin, Steven H.
AU - Weston, Brian
AU - Lee, Jeffrey H.
AU - Bhutani, Manoop S.
AU - Hofstetter, Wayne L.
AU - Swisher, Stephen G.
AU - Ajani, Jaffer A.
N1 - Funding Information:
Supported in part by generous gifts by Caporella, Park, Dallas, Smith, Cantu, Sultan, Frazier and Oaks families. Also supported by the Kevin Fund.
PY - 2012/12
Y1 - 2012/12
N2 - Background: The presence of malignant lymph nodes (+ypNodes) in the surgical specimen after preoperative chemoradiation (trimodality) in patients with oesophageal cancer (EC) portends a poor prognosis for overall survival (OS) and disease-free survival (DFS). Currently, none of the clinical variables highly correlates with +ypNodes. We hypothesised that a combination of clinical variables could generate a model that associates with high likelihood of +ypNodes after trimodality in EC patients. Methods: We report on 293 consecutive EC patients who received trimodality therapy. A multivariate logistic regression analysis that included pretreatment and post-chemoradiation variables identified independent variables that were used to construct a nomogram for +ypNodes after trimodality in EC patients. Results: Of 293 patients, 91 (31.1%) had +ypNodes. OS (p = 0.0002) and DFS (p< 0.0001) were shorter in patients with +ypNodes compared to those with -ypNodes. In multivariable analysis, the significant variables for +ypNodes were: baseline T-stage (odds ratio [OR], 7.145; 95% confidence interval [CI], 1.381-36.969; p = 0.019), baseline N-stage (OR, 2.246; 95% CI, 1.024-4.926; p = 0.044), tumour length (OR, 1.178; 95% CI, 1.024-1.357; p = 0.022), induction chemotherapy (OR, 0.471; 95% CI, 0.242-0.915; p = 0.026), nodal uptake on post-chemoradiation positron emission tomography (OR, 2.923; 95% CI, 1.007-8.485; p = 0.049) and enlarged node(s) on post-chemoradiation computerised tomography (OR, 3.465; 95% CI, 1.549-7.753; p = 0.002). The nomogram after internal validation using the bootstrap method (200 runs) yielded a high concordance index of 0.756. Conclusion: Our nomogram highly correlates with the presence of +ypNodes after chemoradiation, however, considerably more refinement is needed before it can be implemented in the clinic.
AB - Background: The presence of malignant lymph nodes (+ypNodes) in the surgical specimen after preoperative chemoradiation (trimodality) in patients with oesophageal cancer (EC) portends a poor prognosis for overall survival (OS) and disease-free survival (DFS). Currently, none of the clinical variables highly correlates with +ypNodes. We hypothesised that a combination of clinical variables could generate a model that associates with high likelihood of +ypNodes after trimodality in EC patients. Methods: We report on 293 consecutive EC patients who received trimodality therapy. A multivariate logistic regression analysis that included pretreatment and post-chemoradiation variables identified independent variables that were used to construct a nomogram for +ypNodes after trimodality in EC patients. Results: Of 293 patients, 91 (31.1%) had +ypNodes. OS (p = 0.0002) and DFS (p< 0.0001) were shorter in patients with +ypNodes compared to those with -ypNodes. In multivariable analysis, the significant variables for +ypNodes were: baseline T-stage (odds ratio [OR], 7.145; 95% confidence interval [CI], 1.381-36.969; p = 0.019), baseline N-stage (OR, 2.246; 95% CI, 1.024-4.926; p = 0.044), tumour length (OR, 1.178; 95% CI, 1.024-1.357; p = 0.022), induction chemotherapy (OR, 0.471; 95% CI, 0.242-0.915; p = 0.026), nodal uptake on post-chemoradiation positron emission tomography (OR, 2.923; 95% CI, 1.007-8.485; p = 0.049) and enlarged node(s) on post-chemoradiation computerised tomography (OR, 3.465; 95% CI, 1.549-7.753; p = 0.002). The nomogram after internal validation using the bootstrap method (200 runs) yielded a high concordance index of 0.756. Conclusion: Our nomogram highly correlates with the presence of +ypNodes after chemoradiation, however, considerably more refinement is needed before it can be implemented in the clinic.
KW - Nomogram
KW - Oesophageal cancer
KW - Prognosis
KW - Trimodality therapy
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U2 - 10.1016/j.ejca.2012.06.020
DO - 10.1016/j.ejca.2012.06.020
M3 - Article
C2 - 22853875
AN - SCOPUS:84869493016
SN - 0959-8049
VL - 48
SP - 3396
EP - 3404
JO - European Journal of Cancer
JF - European Journal of Cancer
IS - 18
ER -