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Nomogram for prognosis of patients with esophageal squamous cell cancer after minimally invasive esophagectomy established based on non-textbook outcome

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Abstract

Background

Non-textbook outcome (non-TO) represents a new prognostic evaluation index for surgical oncology. The present study aimed to develop new nomograms based on non-TO to predict the mortality and recurrence rate in patients with esophageal squamous cell cancer (ESCC) after minimally invasive esophagectomy (MIE).

Methods

The study involved a retrospective analysis of 613 ESCC patients, from the prospectively maintained database from January 2011 to December 2018. All the included ESCC patients underwent MIE, and they were randomly (1:1) assigned to the training cohort (307 patients) and the validation cohort (306 patients). Kaplan–Meier survival analysis was used to analyze the differences recorded between overall survival (OS) and disease-free survival (DFS). In the case of the training cohort, the nomograms based on non-TO were developed using Cox regression, and the performance of these nomograms was calibrated and evaluated in the validation cohort.

Results

Significant differences were recorded for 5-year OS and DFS between non-TO and TO groups (p < 0.05). Multivariate cox analysis revealed that non-TO, intraoperative bleeding, T stage, and N stage acted as independent risk factors that affected OS and DFS (p < 0.05). The results for multivariate regression were used to build non-TO-based nomograms to predict OS and DFS of patients with ESCC, the t-AUC curve analysis showed that the nomograms predicting OS and DFS were more accurate as compared to TNM staging, during the follow-up period in the training cohort and validation cohort. Further, the nomogram score was used to divide ESCC patients into low-, middle-, and high-risk groups and significant differences were recorded for OS and DFS between these three groups (p < 0.001).

Conclusions

Non-TO was identified as an independent prognostic factor for ESCC patients. The nomograms based on non-TO could availably predict OS and DFS in ESCC patients after MIE.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank all the medical staff who contributed to the maintenance of the medical record database.

Funding

This study was supported by grants from The Program for the Natural Science Foundation in Fujian Province (No. 2020J011004), Medical innovation project in Fujian Province (No. 2020CXA028), the cohort study of the School of Public Health, Fujian Medical University (No. 2021HX003), and Fujian provincial science and technology innovation joint fund project plan (No. 2020Y9076).

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Author notes

  1. Shao-jun Xu and Lan-qin Lin contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China

    Shao-jun Xu, Ting-yu Chen, Cheng-xiong You, Chao Chen, Rui-qin Chen & Shu-chen Chen

  2. Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China

    Shao-jun Xu, Ting-yu Chen, Cheng-xiong You, Chao Chen, Rui-qin Chen & Shu-chen Chen

  3. Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Shao-jun Xu, Ting-yu Chen, Cheng-xiong You, Chao Chen, Rui-qin Chen & Shu-chen Chen

  4. Department of Operation, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Lan-qin Lin

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Contributions

Conception/Design: SCC and SJX. Collection and/or assembly of data: SJX, LQL, TYC, CXY, CC, RQC, and SCC. Data analysis and interpretation: SJX, LQL, TYC, CXY, CC, RQC, and SCC. Manuscript writing: SJX, and SCC. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Shu-chen Chen.

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Disclosures

Shao-jun Xu, Lan-qin Lin, Ting-yu Chen, Cheng-xiong You, Chao Chen, Rui-qin Chen, Shu-chen Chen and have no conflicts of interest or financial ties to disclose.

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This article does not report individual participants’ data in any form.

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Supplementary Information

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Supplementary file1 (TIF 595 kb)—Figure S1 Flow chart of inclusion of research population.

464_2022_9290_MOESM2_ESM.tif

Supplementary file2 (TIF 640 kb)—Figure S2 Textbook outcome: Comprehensive measurement of short-term outcome parameters of ESCC patients undergoing MIE. A Training cohort; B Validation cohort.

464_2022_9290_MOESM3_ESM.tif

Supplementary file3 (TIF 800 kb)—Figure S3 Comparison of predictive accuracy between the nomograms and the TNM staging systems. C-indexes of A OS and B DFS in the training cohort. C-indexes of C OS and D DFS in the validation cohort.

Supplementary file4 (DOCX 24 kb)

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Xu, Sj., Lin, Lq., Chen, Ty. et al. Nomogram for prognosis of patients with esophageal squamous cell cancer after minimally invasive esophagectomy established based on non-textbook outcome. Surg Endosc 36, 8326–8339 (2022). https://doi.org/10.1007/s00464-022-09290-y

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