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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Development and validation of a prognostic nomogram model for Chinese patients with primary small cell carcinoma of the esophagus
Dong-Yun Zhang, Gai-Rong Huang, Jian-Wei Ku, Xue-Ke Zhao, Xin Song, Rui-Hua Xu, Wen-Li Han, Fu-You Zhou, Ran Wang, Meng-Xia Wei, Li-Dong Wang
Dong-Yun Zhang, Department of Pathology, Nanyang Medical College, Nanyang 473061, Henan Province, China
Dong-Yun Zhang, Xue-Ke Zhao, Xin Song, Rui-Hua Xu, Wen-Li Han, Ran Wang, Meng-Xia Wei, Li-Dong Wang, State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan Province, China
Gai-Rong Huang, Department of Geriatrics, Henan People’s Hospital, Zhengzhou 450003, Henan Province, China
Jian-Wei Ku, Department of Endoscopy of The Third Affiliated Hospital, Nanyang Medical College, Nanyang 473061, Henan Province, China
Fu-You Zhou, Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang 455000, Henan Province, China
Author contributions: Wang LD, Zhang DY, and Huang GR designed and wrote the paper; Ku JW, Xu RH, Han WL, Wang R, Wei MX, and Zhou FY performed the data collection and interpretation and follow-up; Zhang DY, Zhao XK, and Song X contributed to the data analysis; all authors approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81872032 and No. U1804262; the National Key R&D Program of China, No. 2016YFC0901403; the High-Tech Key Projects of High School of Henan Province, No. 20B320011; and the High-Tech Key Projects of Science and Technology of Henan Province Government, No. 202102310366.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University. The research content and process of the project followed the international and national ethical requirements for biomedical research.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
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:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Li-Dong Wang, MD, PhD, Professor, State Key Laboratory of Esophageal Cancer Prevention and 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: March 4, 2021
Peer-review started: March 4, 2021
First decision: June 3, 2021
Revised: June 19, 2021
Accepted: August 18, 2021
Article in press: August 18, 2021
Published online: October 26, 2021
ARTICLE HIGHLIGHTS
Research background
Primary small cell carcinoma of the esophagus (PSCE) is a rare tumor, accounting for 0.05% to 3.1% of all esophageal malignancies and approximately 2% of extrapulmonary small cell carcinomas. PSCE patients seem to have earlier metastasis and a worse prognosis than those with esophageal squamous cell carcinoma, which requires a more accurate prognostic prediction model.
Research motivation
Several previous studies have reported the prognostic factors for PSCE with controversial results, partly due to their small sample size. To date, only one nomogram has been used to predict the overall survival probability for PSCE patients in the United States. In addition, the model did not include relevant neuroendocrine markers.
Research objectives
The present study aimed to build a prognostic predictive nomogram model including clinicopathological factors and neuroendocrine biomarkers for Chinese PSCE patients. It was also determined whether the nomogram model can predict overall survival (OS) more accurately than the 7th tumor-node-metastasis (TNM) staging system.
Research methods
The nomogram was based on a retrospective study of 256 PSCE patients, derived from our esophageal and gastric cardia carcinoma database including 500000 cases (1973-2015), established by State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital of Zhengzhou University in Henan, China. The predictive accuracy and discriminative ability of the nomogram were determined by the concordance index (C-index), calibration plot, and decision curve analysis (DCA), and the results were also compared with the 7th TNM staging.
Research results
The final nomogram model included histology type, age, tumor invasion depth, lymph node invasion, distant metastases, chromogranin A, and neuronal cell adhesion molecule 56. The C-index of the model had a prognostic superiority over the 7th edition TNM staging system in both the primary cohort [0.659 (95%CI: 0.607-0.712) vs 0.591 (95%CI: 0.517-0.666), P = 0.033] and the validation cohort [0.700 (95%CI: 0.622-0.778) vs 0.605 (95%CI: 0.490-0.721), P = 0.041]. Good calibration curves were observed for the prediction probabilities of 1-, 3- and 5-year OS in the primary and validation cohorts. DCA analysis showed that our nomogram model had a higher overall net benefit than the 7th TNM staging.
Research conclusions
We have developed and validated a nomogram for predicting 1-year, 3-year, and 5-year OS in Chinese PSCE patients. The new nomogram classifies patients into different risk subgroups and shows a superiority of survival prediction over the 7th TNM staging.
Research perspectives
The nomogram model can be used to predict the survival probability of PSCE patients, which might help clinicians to make individualized prognosis predictions and give better treatment recommendations for PSCE patients in China.
