Clinical and Translational Research
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2024; 16(6): 2541-2554
Published online Jun 15, 2024. doi: 10.4251/wjgo.v16.i6.2541
Development of a novel staging classification for Siewert II adenocarcinoma of the esophagogastric junction after neoadjuvant chemotherapy
Jian Zhang, Hao Liu, Hang Yu, Wei-Xiang Xu
Jian Zhang, Hao Liu, Hang Yu, Wei-Xiang Xu, Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Co-first authors: Jian Zhang and Hao Liu.
Author contributions: Zhang J performed the conceptualization and design; Liu H, Yu H, and Xu WX collected and summarized the data; Zhang J, Hao Liu, Hang Yu and Xu WX performed data analysis and interpretation; Zhang J, Liu H and Yu H wrote the manuscript. All authors read and approved the final manuscript.
Supported by Key R&D Program of Zhejiang, No. 2023C03172.
Institutional review board statement: The SEER registries provide de-identified data. Consequently, this study does not require Institutional Review Board (IRB) review or approval.
Informed consent statement: Because the information in the SEER database does not require the patient's explicit consent, the study is waived from Informed consent statement.
Conflict-of-interest statement: None of the authors have any competing interests in the manuscript.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the SEER database. Available at https://seer.cancer.gov/.
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: Jian Zhang, MD, Chief, Chief Doctor, Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 1367 West Wenyi Road, Yuhang District, Hangzhou 310003, Zhejiang Province, China. ljzju001@126.com
Received: October 21, 2023
Revised: January 27, 2024
Accepted: April 15, 2024
Published online: June 15, 2024
Processing time: 237 Days and 17.8 Hours
Abstract
BACKGROUND

Stage classification for Siewert II adenocarcinoma of the esophagogastric junction (AEG) treated with neoadjuvant chemotherapy (NAC) has not been established.

AIM

To investigate the optimal stage classification for Siewert II AEG with NAC.

METHODS

A nomogram was established based on Cox regression model that analyzed variables associated with overall survival (OS) and disease-specific survival (DSS). The nomogram performance in terms of discrimination and calibration ability was evaluated using the likelihood-ratio test, Akaike information criterion, Harrell concordance index, time-receiver operating characteristic curve, and decision curve analysis.

RESULTS

Data from 725 patients with Siewert type II AEG who underwent neoadjuvant therapy and gastrectomy were obtained from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate analyses revealed that sex, marital status, race, ypT stage, and ypN stage were independent prognostic factors of OS, whereas sex, race, ypT stage, and ypN stage were independent prognostic factors for DSS. These factors were incorporated into the OS and DSS nomograms. Our novel nomogram model performed better in terms of OS and DSS prediction compared to the 8th American Joint Committee of Cancer pathological staging system for esophageal and gastric cancer. Finally, a user-friendly web application was developed for clinical use.

CONCLUSION

The nomogram established specifically for patients with Siewert type II AEG receiving NAC demonstrated good prognostic performance. Validation using external data is warranted before its widespread clinical application.

Keywords: Stage classification; Prognosis; Esophagogastric junction cancer; Neoadjuvant chemotherapy; Siewert type

Core Tip: So far, the ideal staging classification for Siewert II AEG treated with neoadjuvant chemotherapy is lacking. Thus, we established nomogram based on the Cox regression model which incorporating variables associated with overall survival (OS) and disease-specific survival (DSS). The novel nomogram model showed the best performance compared with 8th American Joint Committee of Cancer pathological staging schemes of esophagus cancer and gastric cancer. The time-receiver operating characteristic curve of the novel nomogram showed an excellent predictive value in terms of 5-year OS [0.665 (0.626-0.704)] and 5-year DSS [0.675 (0.636-0.713)]. Finally, a friendly online web application was developed for clinical use.