Focus on patients with early esophageal cancer-a prognostic nomogram

Esophageal cancer is a common cancer of the digestive system, with high morbidity and poor prognosis. However, while the prognosis of early esophageal cancer is relatively good, there is no effective model to accurately predict the prognosis of early esophageal cancer. The Aims of this study are to explore risk factors for the prognosis of early esophageal cancer and to establish a prediction nomogram for patients.

Surveillance, Epidemiology and End Results (SEER) Stat 8.3.5 was used to collect 2,351 cases of early esophageal cancer from 2004 to 2015 in the SEER database. Early esophageal cancer is defined as a lesion that is confined to the lamina propria and the muscularis mucosa. Prognostic factors were analyzed with the log-rank method and a Cox proportional hazard model by SPSS (v25.0). Independent prognostic factors were used to construct a nomogram with a Cox proportional hazard model. The C-index was used to evaluate the prediction effect of the nomogram. The internal validity of the nomogram was tested by discrimination and calibration using a bootstrap method with 1,000 resamplings.

The median survival time was 30 months, and the 1-, 3-, and 5-year survival rates were 65.2%, 46.8%, and 41.6%, respectively. The male to female ratio was 3:1, and 85.33% of all patients were white. Univariate analysis showed that risk factors affecting patient prognosis included age (χ²=430.631, P<0.001), sex (χ²=48.1, P<0.001), marital status (χ²=107.597, P<0.001), race (χ²=58.928, P<0.001), primary site (χ²=98.675, P<0.001), tumor grade (χ²=116.421, P<0.001), surgery (χ²=1,259.33, P<0.001) and histologic type (χ²=231.062, P<0.001). Using multivariate analysis, we found that age (HR=1.787, 95% CI: 1.58-2.03), marital status (HR=0.774, 95% CI: 0.69-0.87), tumor grade (HR=1.241, 95% CI: 1.14-135), and surgery (HR=0.356, 95% CI: 0.33-0.39) were independent prognostic factors for patients with early esophageal cancer. We constructed the nomogram with the above independent factors, and the C-index value was 0.788.

This study obtained the latest epidemiological information on early esophageal cancer and determined that age, marital status, tumor grade and surgery were independent prognostic factors for early esophageal cancer. The nomogram developed with these factors could provide good prognosis prediction.