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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Development and validation of a prognostic nomogram model for Chinese patients with primary small cell carcinoma of the esophagus
Dong-Yun Zhang, Gai-Rong Huang, Jian-Wei Ku, Xue-Ke Zhao, Xin Song, Rui-Hua Xu, Wen-Li Han, Fu-You Zhou, Ran Wang, Meng-Xia Wei, Li-Dong Wang
Dong-Yun Zhang, Department of Pathology, Nanyang Medical College, Nanyang 473061, Henan Province, China
Dong-Yun Zhang, Xue-Ke Zhao, Xin Song, Rui-Hua Xu, Wen-Li Han, Ran Wang, Meng-Xia Wei, Li-Dong Wang, State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan Province, China
Gai-Rong Huang, Department of Geriatrics, Henan People’s Hospital, Zhengzhou 450003, Henan Province, China
Jian-Wei Ku, Department of Endoscopy of The Third Affiliated Hospital, Nanyang Medical College, Nanyang 473061, Henan Province, China
Fu-You Zhou, Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang 455000, Henan Province, China
Author contributions: Wang LD, Zhang DY, and Huang GR designed and wrote the paper; Ku JW, Xu RH, Han WL, Wang R, Wei MX, and Zhou FY performed the data collection and interpretation and follow-up; Zhang DY, Zhao XK, and Song X contributed to the data analysis; all authors approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81872032 and No. U1804262; the National Key R&D Program of China, No. 2016YFC0901403; the High-Tech Key Projects of High School of Henan Province, No. 20B320011; and the High-Tech Key Projects of Science and Technology of Henan Province Government, No. 202102310366.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University. The research content and process of the project followed the international and national ethical requirements for biomedical research.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no potential conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Li-Dong Wang, MD, PhD, Professor, State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450052, Henan Province, China.
ldwangpaper2018@126.com
Received: March 4, 2021
Peer-review started: March 4, 2021
First decision: June 3, 2021
Revised: June 19, 2021
Accepted: August 18, 2021
Article in press: August 18, 2021
Published online: October 26, 2021
Processing time: 231 Days and 0.4 Hours
BACKGROUND
Primary small cell carcinoma of the esophagus (PSCE) is a highly invasive malignant tumor with a poor prognosis compared with esophageal squamous cell carcinoma. Due to the limited samples size and the short follow-up time, there are few reports on elucidating the prognosis of PSCE, especially on the establishment and validation of a survival prediction nomogram model covering general information, pathological factors and specific biological proteins of PSCE patients.
AIM
To establish an effective nomogram to predict the overall survival (OS) probability for PSCE patients in China.
METHODS
The nomogram was based on a retrospective study of 256 PSCE patients. Univariate analysis and multivariate Cox proportional hazards regression analysis were used to examine the prognostic factors associated with PSCE, and establish the model for predicting 1-, 3-, and 5-year OS based on the Akaike information criterion. Discrimination and validation were assessed by the concordance index (C-index) and calibration curve and decision curve analysis (DCA). Histology type, age, tumor invasion depth, lymph node invasion, detectable metastasis, chromogranin A, and neuronal cell adhesion molecule 56 were integrated into the model.
RESULTS
The C-index was prognostically superior to the 7th tumor node metastasis (TNM) staging in the primary cohort [0.659 (95%CI: 0.607-0.712) vs 0.591 (95%CI: 0.517-0.666), P = 0.033] and in the validation cohort [0.700 (95%CI: 0.622-0.778) vs 0.605 (95%CI: 0.490-0.721), P = 0.041]. Good calibration curves were observed for the prediction probabilities of 1-, 3-, and 5-year OS in both cohorts. DCA analysis showed that our nomogram model had a higher overall net benefit compared to the 7th TNM staging .
CONCLUSION
Our nomogram can be used to predict the survival probability of PSCE patients, which can help clinicians to make individualized survival predictions.
Core Tip: Up to now, the main prognostic index of primary small cell carcinoma of the esophagus (PSCE) is still the disease stage, which is mainly based on the American Joint Committee on Cancer tumor node metastasis classification of esophageal squamous cell carcinoma. A large amount of evidence shows that the staging system cannot well evaluate the clinical outcome of PSCE. Compared with the traditional staging system, our nomogram model can accurately evaluate the overall survival probability at 1, 3, and 5 years for PSCE patients in China.
