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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Increased prognostic value of clinical–reproductive model in Chinese female patients with esophageal squamous cell carcinoma
Dong-Yun Zhang, Jian-Wei Ku, Xue-Ke Zhao, Hai-Yan Zhang, Xin Song, Hong-Fang Wu, Zong-Min Fan, Rui-Hua Xu, Duo You, Ran Wang, Ruo-Xi Zhou, Li-Dong Wang
Dong-Yun Zhang, Xue-Ke Zhao, Xin Song, Zong-Min Fan, Rui-Hua Xu, Duo You, Ran Wang, Li-Dong Wang, State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan Province, China
Dong-Yun Zhang, Hong-Fang Wu, Department of Pathology, Nanyang Medical College, Nanyang 473061, Henan Province, China
Jian-Wei Ku, Department of Endoscopy, The Third Affiliated Hospital, Nanyang Medical College, Nanyang 473061, Henan Province, China
Hai-Yan Zhang, Department of Pathology, The First Affiliated Hospital, Nanyang Medical College, Nanyang 473061, Henan Province, China
Duo You, Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450052, Henan Province, China
Ruo-Xi Zhou, Department of Biology, University of Richmond, Richmond, VA 23173, United States
Author contributions: Wang LD and Zhang DY designed and wrote the paper; Ku JW, Xu RH, Wang R, Wu HF, and Fan ZM performed the data collection, interpretation and follow-up; Zhang DY, Zhao XK, Zhou RX, and Song X contributed to the data analysis; all authors performed the final approvlement.
Supported by National Natural Science Foundation of China, No. 81872032 and No. U1804262; National Key R&D Program of China, No. 2016YFC0901403; High-Tech Key Projects of High School of Henan Province, No. 20B320011; and High-Tech Key Projects of Science and Technology of Henan Province Government, No. 202102310366.
Institutional review board statement: This research content and process of the project followed the international and national ethical requirements for biomedical research and agreed to publish. The study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University and Institutional Review Board of the First Affiliated Hospital of Nanyang Medical College.
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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Li-Dong Wang, MD, PhD, Professor, State Key Laboratory of Esophageal Cancer Prevention & 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: October 25, 2021
Peer-review started: October 25, 2021
First decision: January 9, 2022
Revised: January 21, 2022
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: April 7, 2022
ARTICLE HIGHLIGHTS
Research background
Nomogram has been widely used and proved to be more accurate than the tumor-node-metastasis (TNM) staging system for predicting prognosis in different cancers. In China, female patients with esophageal squamous cell carcinoma (ESCC), even with the same TNM stage, had distinct overall survival (OS) difference, which requires an effective prediction model to accurately evaluate the prognosis.
Research motivation
Several studies have developed some prognosis nomogram models, which provide useful tools for predicting OS probability in patients with esophageal cancer. The included patients were mainly extracted from the Surveillance, Epidemiology, and Final Results (SEER) database in United States. Due to the ethnic difference, the models are not entirely applicable to perform the OS prediction for Chinese female ESCC.
Research objectives
The purpose of the study was to develop and validate a clinical-reproductive model for predicting OS in Chinese female patients with ESCC, and to further explore whether the model had higher prognostic value than the clinical model and TNM stage.
Research methods
A new prognostic nomogram incorporating clinical and reproductive characteristics was constructed in the primary training cohort and verified in the internal and external validation cohorts. The performance of the full model was evaluated by Kaplan-Meier curve, time-dependent receiver operating characteristic (ROC) curve, Harrell’s concordance index (C-index), calibration curve and decision curve analysis.
Research results
The clinical-reproductive model incorporated incidence area, age, differentiation, N stage, estrogen receptor alpha expression, estrogen receptor beta expression, menopausal age, and pregnancy number. Compared to the clinical model and TNM stage, the ROC curve and C-index indicated good discriminative ability of the full model for predicting 1-, 3-, and 5-years OS in the primary, internal, and external validation sets.
Research conclusions
A clinical-reproductive nomogram for OS prediction in Chinese female ESCC was developed and validated in the present study, which showed superior survival prediction than the clinical model and TNM stage.
Research perspectives
The clinical–reproductive model has incremental prognostic predictive value in Chinese female ESCC, which may be beneficial to individualized treatment and medical decision-making.
