Development of a prognostic nomogram and risk stratification system for elderly patients with esophageal squamous cell carcinoma undergoing definitive radiotherapy: a multicenter retrospective analysis (3JECROG R-03 A)
Abstract Background Our goal is to develop a nomogram model to predict overall survival (OS) for elderly esophageal squamous cell carcinoma (ESCC) patients receiving definitive radiotherapy (RT) or concurrent chemoradiotherapy (CRT), aiding clinicians in personalized treatment planning with a risk s...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12885-024-13414-z |
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| author | Yuanji Xu Chuyan Lin Chun Han Xin Wang Yidian Zhao Qingsong Pang Xinchen Sun Gaofeng Li Kaixian Zhang Ling Li Xueying Qiao Yu Lin Zefen Xiao Junqiang Chen |
| author_facet | Yuanji Xu Chuyan Lin Chun Han Xin Wang Yidian Zhao Qingsong Pang Xinchen Sun Gaofeng Li Kaixian Zhang Ling Li Xueying Qiao Yu Lin Zefen Xiao Junqiang Chen |
| author_sort | Yuanji Xu |
| collection | DOAJ |
| description | Abstract Background Our goal is to develop a nomogram model to predict overall survival (OS) for elderly esophageal squamous cell carcinoma (ESCC) patients receiving definitive radiotherapy (RT) or concurrent chemoradiotherapy (CRT), aiding clinicians in personalized treatment planning with a risk stratification system. Methods A retrospective study was conducted on 718 elderly ESCC patients treated with RT or CRT at 10 medical centers (3JECROG) from January 2004 to November 2016. We identified independent prognostic factors using univariate and multifactorial Cox regression to construct a nomogram model. Its effectiveness was evaluated using concordance statistics (C-index), area under the curve (AUC), net reclassification index (NRI), and integrated discrimination improvement (IDI), and compared against the AJCC staging. Additionally, decision curve analysis (DCA) assessed the model’s clinical benefit. Patients were stratified into low, intermediate, and high-risk groups using the nomogram, and their prognoses in various disease stages were analyzed. Results Significant prognostic factors identified included diabetes, tumor volume (GTVp), tumor length, location, and clinical stages (T, N, M), and RT response. Multivariate analysis confirmed these as independent factors for OS. The nomogram outperformed AJCC staging in prediction accuracy and discrimination, evidenced by a higher C-index, better AUC, and significant NRI and IDI values. Patients categorized by the nomogram demonstrated distinct 5-year OS rates, with a higher C-index than AJCC staging (0.597 vs. 0.562) . Conclusions The study identified key prognostic factors for elderly ESCC patients receiving RT or CRT. The nomogram model, based on these factors, showed enhanced prediction performance, discrimination, and clinical utility compared to AJCC staging. This risk stratification provided more accurate survival predictions and aided in personalized risk management. |
| format | Article |
| id | doaj-art-bc30981607ab4d1bb69f3cf1874914bf |
| institution | Kabale University |
| issn | 1471-2407 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj-art-bc30981607ab4d1bb69f3cf1874914bf2025-01-12T12:27:42ZengBMCBMC Cancer1471-24072025-01-0125111110.1186/s12885-024-13414-zDevelopment of a prognostic nomogram and risk stratification system for elderly patients with esophageal squamous cell carcinoma undergoing definitive radiotherapy: a multicenter retrospective analysis (3JECROG R-03 A)Yuanji Xu0Chuyan Lin1Chun Han2Xin Wang3Yidian Zhao4Qingsong Pang5Xinchen Sun6Gaofeng Li7Kaixian Zhang8Ling Li9Xueying Qiao10Yu Lin11Zefen Xiao12Junqiang Chen13Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer HospitalInterventional Ward, Department of Radiology, 900 Hospital of the Joint Logistics TeamDepartment of Radiation Oncology, the Fourth Hospital of Hebei Medical UniversityDepartment of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment 4th of Radiation Oncology, Anyang Cancer HospitalDepartment of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for CancerDepartment of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical UniversityDepartment of Radiation Oncology, Beijing Hospital, National Center of GerontologyDepartment of Oncology, Tengzhou Central People’s HospitalDepartment of Oncology, Tengzhou Central People’s HospitalDepartment of Radiation Oncology, the Fourth Hospital of Hebei Medical UniversityDepartment of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer HospitalDepartment of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer HospitalAbstract Background Our goal is to develop a nomogram model to predict overall survival (OS) for elderly esophageal squamous cell carcinoma (ESCC) patients receiving definitive radiotherapy (RT) or concurrent chemoradiotherapy (CRT), aiding clinicians in personalized treatment planning with a risk stratification system. Methods A retrospective study was conducted on 718 elderly ESCC patients treated with RT or CRT at 10 medical centers (3JECROG) from January 2004 to November 2016. We identified independent prognostic factors using univariate and multifactorial Cox regression to construct a nomogram model. Its effectiveness was evaluated using concordance statistics (C-index), area under the curve (AUC), net reclassification index (NRI), and integrated discrimination improvement (IDI), and compared against the AJCC staging. Additionally, decision curve analysis (DCA) assessed the model’s clinical benefit. Patients were stratified into low, intermediate, and high-risk groups using the nomogram, and their prognoses in various disease stages were analyzed. Results Significant prognostic factors identified included diabetes, tumor volume (GTVp), tumor length, location, and clinical stages (T, N, M), and RT response. Multivariate analysis confirmed these as independent factors for OS. The nomogram outperformed AJCC staging in prediction accuracy and discrimination, evidenced by a higher C-index, better AUC, and significant NRI and IDI values. Patients categorized by the nomogram demonstrated distinct 5-year OS rates, with a higher C-index than AJCC staging (0.597 vs. 0.562) . Conclusions The study identified key prognostic factors for elderly ESCC patients receiving RT or CRT. The nomogram model, based on these factors, showed enhanced prediction performance, discrimination, and clinical utility compared to AJCC staging. This risk stratification provided more accurate survival predictions and aided in personalized risk management.https://doi.org/10.1186/s12885-024-13414-zElderly ESCCDefinitive radiotherapyNomogram modelAJCC stagingRisk stratification |
| spellingShingle | Yuanji Xu Chuyan Lin Chun Han Xin Wang Yidian Zhao Qingsong Pang Xinchen Sun Gaofeng Li Kaixian Zhang Ling Li Xueying Qiao Yu Lin Zefen Xiao Junqiang Chen Development of a prognostic nomogram and risk stratification system for elderly patients with esophageal squamous cell carcinoma undergoing definitive radiotherapy: a multicenter retrospective analysis (3JECROG R-03 A) BMC Cancer Elderly ESCC Definitive radiotherapy Nomogram model AJCC staging Risk stratification |
| title | Development of a prognostic nomogram and risk stratification system for elderly patients with esophageal squamous cell carcinoma undergoing definitive radiotherapy: a multicenter retrospective analysis (3JECROG R-03 A) |
| title_full | Development of a prognostic nomogram and risk stratification system for elderly patients with esophageal squamous cell carcinoma undergoing definitive radiotherapy: a multicenter retrospective analysis (3JECROG R-03 A) |
| title_fullStr | Development of a prognostic nomogram and risk stratification system for elderly patients with esophageal squamous cell carcinoma undergoing definitive radiotherapy: a multicenter retrospective analysis (3JECROG R-03 A) |
| title_full_unstemmed | Development of a prognostic nomogram and risk stratification system for elderly patients with esophageal squamous cell carcinoma undergoing definitive radiotherapy: a multicenter retrospective analysis (3JECROG R-03 A) |
| title_short | Development of a prognostic nomogram and risk stratification system for elderly patients with esophageal squamous cell carcinoma undergoing definitive radiotherapy: a multicenter retrospective analysis (3JECROG R-03 A) |
| title_sort | development of a prognostic nomogram and risk stratification system for elderly patients with esophageal squamous cell carcinoma undergoing definitive radiotherapy a multicenter retrospective analysis 3jecrog r 03 a |
| topic | Elderly ESCC Definitive radiotherapy Nomogram model AJCC staging Risk stratification |
| url | https://doi.org/10.1186/s12885-024-13414-z |
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