Increased prognostic value of clinical–reproductive model in Chinese female patients with esophageal squamous cell carcinoma

Figure 1 Survival analysis for female patients with esophageal squamous cell carcinoma in primary training cohort. A: Univariate analysis; B: Multivariate analysis; C-I: Survival curves for patients with incidence area, lymph node metastasis, surgery methods, estrogen receptor alpha, estrogen receptor beta, menarche age, and pregnancy number, respectively. T: Tumor invasion depth; ESR1: Estrogen receptor alpha; ESR2: Estrogen receptor beta; N: Lymph node metastasis.

Figure 2 The Clinical-reproductive model for predicting 1-, 3-, and 5-yr overall survival probability in female patients with esophageal squamous cell carcinoma. ESR1: Estrogen receptor alpha; ESR2: Estrogen receptor beta; N: Lymph node metastasis.

Figure 3 Evaluation of full model performance in the primary training set and confirmation based on both internal and external validation sets. A, C, and E: Distribution of risk scores and survival status in primary training, internal and external validation sets, respectively; B, D, and F: Kaplan-Meier survival curves in primary training, internal and external validation sets, respectively.

Figure 4 Stratified analysis of the clinical-reproductive model in different subgroups. T: Tumor invasion depth, N: Lymph node metastasis; ESR1: Estrogen receptor alpha; ESR2: Estrogen receptor beta.

Figure 5 Calibration curves and time-dependent receiver operating characteristic curves for validation of clinical-reproductive model in the primary training, internal and external validation cohorts. A and B: Calibration curves for predicting 1-, 3-, and 5-yr overall survival and time-dependent receiver operating characteristic (ROC) curves in primary training cohort; C and D: Calibration curves and time-dependent ROC curves in internal validation cohort; E and F: Calibration curves and time-dependent ROC curves in external validation cohort. OS: Overall survival.

Figure 6 Calibration curves and time-dependent receiver operating characteristic curves of 1-, 3-, and 5-yr overall survival prediction for the full model, clinical model and tumor-node-metastasis stage in the primary training set. A-C: Calibration curves for predicting 1-, 3-, and 5-yr overall survival (OS) in primary training set, respectively; D-F: Time-dependent receiver operating characteristic curves of 1-, 3-, and 5 yr OS prediction in primary training cohort, respectively. Full model: Pregnancy number + menopausal age + estrogen receptor alpha + estrogen receptor beta + N stage + differentiation + diagnose age + incidence area; Clinical model: N stage + differentiation + diagnose age + incidence area; TNM stage: Tumor-node-metastasis stage.

Figure 7 Decision curve analysis for full model, clinical model, and tumor node metastasis stage. Black line: All patients were dead. Gray line: None of patients was dead. Full model: Pregnancy number + menopausal age + estrogen receptor alpha + estrogen receptor beta + N stage + differentiation + diagnose age + incidence area; Clinical model: N stage + differentiation + diagnose age+ incidence area; TNM stage: Tumor-node-metastasis stage.

Figure 8 Clinical relevance of full model. Distribution of the risk score based on different tumor-node-metastasis (TNM) stage, lymph node metastasis (N) stage, and tumor invasion depth (T) stage in the primary training cohort. A: TNM stage; B: N stage; C: T stage. ^aP < 0.001. T: Tumor invasion depth, N: Lymph node metastasis; TNM stage: Tumor-node-metastasis stage.

Figure 9 Screenshot from the web-based nomogram for predicting 1-, 3-, and 5-yr overall survival for female patients with esophageal squamous cell carcinoma. N: Lymph node metastasis; ESR1: Estrogen receptor alpha; ESR2: Estrogen receptor beta.