This investigation defined patient populations at high-, intermediate-, and low-risk of recurrence with thoracic esophageal carcinoma after radical surgery using clinical nomograms and recursive partitioning analysis (RPA).
A retrospective review of 3,480 patients diagnosed as esophageal carcinoma in Chinese Academy of Medical Science, Cancer hospital between January 2004 and May 2009 was performed. A database compiling 1,119 patents with thoracic esophageal carcinoma after surgery with or without postoperative radiation was created. Logistic analysis was performed to identify factors to be included in a RPA to predict for 5-year disease-free survival. A 5-year disease-free survival clinical nomogram was conducted and validated (c-index statistic).
Median follow-up time was 86.1 months for all the patients. Length of tumor, treatment modality, upper margin,T stage, Lymph node metastatic ratio and vascular emboli were found to be statistically significant predictors of the 5-year disease-free survival. RPA classifications were defined as follows: low risk (5-year disease-free survival:55%): positive lymph node ratio >0.073; intermediate risk (5-year disease-free survival42%): T1-2 stage with lymph node metastatic ratio(LNMR) > 0.073 received surgery alone OR LNMR > 0.073 and received postoperative irradiation; high risk (5-year disease-free survival 10%):T3-4 stage, and LMNR > 0.073 and without postoperative irradiation. These classifications were highly statistically significant for overall survival (P < 0.001). A clinical nomogram containing the six factors for the prediction of 5-year disease-free survival was created(c-index 0.646).
A risk-adapted treatment approach can be applied for thoracic esophageal carcinoma after radical surgery using RPA categories and / or nomogram-based risk estimates. Postoperative irradiation might improve disease-free survival for T3-4 stage with LNMR >0.073.
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All authors have declared no conflicts of interest.