TY - JOUR
T1 - Preoperative Nomogram to Risk Stratify Patients for the Benefit of Trimodality Therapy in Esophageal Adenocarcinoma
AU - Goense, Lucas
AU - van Rossum, Peter S.N.
AU - Xi, Mian
AU - Maru, Dipen M.
AU - Carter, Brett W.
AU - Meijer, Gert J.
AU - Ho, Linus
AU - van Hillegersberg, Richard
AU - Hofstetter, Wayne L.
AU - Lin, Steven H.
N1 - Funding Information:
DISCLOSURE SHL received research funding from STCube Pharmaceuticals, Genetech, Peregrine Pharmaceuticals, Hitachi Chemical, and honorarium from AstraZeneca. All other authors report no conflicts of interest.
Funding Information:
ACKNOWLEDGEMENTS Lucas Goense was supported by the René Vogels Foundation, Oirschot, The Netherlands.
Publisher Copyright:
© 2018, The Author(s).
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Purpose: To develop a nomogram that estimates 1-year recurrence-free survival (RFS) after trimodality therapy for esophageal adenocarcinoma and to assess the overall survival (OS) benefit of esophagectomy after chemoradiotherapy (CRT) on the basis of 1-year recurrence risk. Methods: In total, 568 consecutive patients with potentially resectable esophageal adenocarcinoma who underwent CRT were included for analysis, including 373 patients who underwent esophagectomy after CRT (trimodality therapy), and 195 who did not undergo surgery (bimodality therapy). A nomogram for 1-year RFS was created using a Cox regression model. The upper tertile of the nomogram score was used to stratify patients in low-risk and high-risk groups for 1-year recurrence. The 5-year OS was compared between trimodality and bimodality therapy in low-risk and high-risk patients after propensity score matching, respectively. Results: Median follow-up for the entire cohort was 62 months. The 5-year OS in the trimodality and bimodality treatment groups was 56.3% (95% confidence interval [CI] 47.9–64.7) and 36.9% (95% CI 31.4–42.4), respectively. The final nomogram for the prediction of 1-year RFS included male gender, poor histologic grade, signet ring cell adenocarcinoma, cN1, cN2-3, and baseline SUVmax, with accurate calibration and reasonable discrimination (C-statistic: 0.66). Trimodality therapy was associated with improved 5-year OS in low-risk patients (p = 0.003), whereas it showed no significant survival benefit in high-risk patients (p = 0.302). Conclusions: The proposed nomogram estimates early recurrence risk. The addition of surgery to CRT provides a clear OS benefit in low-risk patients. The OS benefit of surgery in high-risk patients is less pronounced.
AB - Purpose: To develop a nomogram that estimates 1-year recurrence-free survival (RFS) after trimodality therapy for esophageal adenocarcinoma and to assess the overall survival (OS) benefit of esophagectomy after chemoradiotherapy (CRT) on the basis of 1-year recurrence risk. Methods: In total, 568 consecutive patients with potentially resectable esophageal adenocarcinoma who underwent CRT were included for analysis, including 373 patients who underwent esophagectomy after CRT (trimodality therapy), and 195 who did not undergo surgery (bimodality therapy). A nomogram for 1-year RFS was created using a Cox regression model. The upper tertile of the nomogram score was used to stratify patients in low-risk and high-risk groups for 1-year recurrence. The 5-year OS was compared between trimodality and bimodality therapy in low-risk and high-risk patients after propensity score matching, respectively. Results: Median follow-up for the entire cohort was 62 months. The 5-year OS in the trimodality and bimodality treatment groups was 56.3% (95% confidence interval [CI] 47.9–64.7) and 36.9% (95% CI 31.4–42.4), respectively. The final nomogram for the prediction of 1-year RFS included male gender, poor histologic grade, signet ring cell adenocarcinoma, cN1, cN2-3, and baseline SUVmax, with accurate calibration and reasonable discrimination (C-statistic: 0.66). Trimodality therapy was associated with improved 5-year OS in low-risk patients (p = 0.003), whereas it showed no significant survival benefit in high-risk patients (p = 0.302). Conclusions: The proposed nomogram estimates early recurrence risk. The addition of surgery to CRT provides a clear OS benefit in low-risk patients. The OS benefit of surgery in high-risk patients is less pronounced.
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U2 - 10.1245/s10434-018-6435-4
DO - 10.1245/s10434-018-6435-4
M3 - Article
C2 - 29569125
AN - SCOPUS:85044282012
SN - 1068-9265
VL - 25
SP - 1598
EP - 1607
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 6
ER -