Eelke Lucie Anne Toxopeus1, Daan Nieboer2, Joel Shapiro3, Katharina Biermann4, Ate van der Gaast5, Carolien M van Rij6, Ewout Willem Steyerberg2, Joseph Jan Baptiste van Lanschot3, Bas Peter Louis Wijnhoven3. 1. Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. Electronic address: e.toxopeus@erasmusmc.nl. 2. Centre for Medical Decision Making, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. 3. Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. 4. Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. 5. Department of Medical Oncology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. 6. Department of Radiation Oncology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
Abstract
BACKGROUND: A pathologically complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) is seen in 30% of the patients with oesophageal cancer. The aim is to identify patient and tumour characteristics associated with a pCR and to develop a nomogram for the prediction of pCR. PATIENTS AND METHODS: Patients who underwent nCRT followed by surgery were identified and response to nCRT was assessed according to a modified Mandard classification in the resection specimen. A model was developed with age, gender, histology and location of the tumour, differentiation grade, alcohol use, smoking, percentage weight loss, Charlson Comorbidity Index (CCI), cT-stage and cN-stage as potential predictors for pCR. Probability of pCR was studied via logistic regression. Performance of the prediction nomogram was quantified using the concordance statistic (c-statistic) and corrected for optimism. RESULTS: A total of 381 patients were included. After surgery, 27.6% of the tumours showed a pCR. Female sex, squamous cell histology, poor differentiation grade, and low cT-stage were predictive for a pCR with a c-statistic of 0.64 (corrected for optimism). CONCLUSION: A nomogram for the prediction of pathologically complete response after neoadjuvant chemoradiotherapy was developed, with a reasonable predictive power. This nomogram needs external validation before it can be used for individualised clinical decision-making.
BACKGROUND: A pathologically complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) is seen in 30% of the patients with oesophageal cancer. The aim is to identify patient and tumour characteristics associated with a pCR and to develop a nomogram for the prediction of pCR. PATIENTS AND METHODS: Patients who underwent nCRT followed by surgery were identified and response to nCRT was assessed according to a modified Mandard classification in the resection specimen. A model was developed with age, gender, histology and location of the tumour, differentiation grade, alcohol use, smoking, percentage weight loss, Charlson Comorbidity Index (CCI), cT-stage and cN-stage as potential predictors for pCR. Probability of pCR was studied via logistic regression. Performance of the prediction nomogram was quantified using the concordance statistic (c-statistic) and corrected for optimism. RESULTS: A total of 381 patients were included. After surgery, 27.6% of the tumours showed a pCR. Female sex, squamous cell histology, poor differentiation grade, and low cT-stage were predictive for a pCR with a c-statistic of 0.64 (corrected for optimism). CONCLUSION: A nomogram for the prediction of pathologically complete response after neoadjuvant chemoradiotherapy was developed, with a reasonable predictive power. This nomogram needs external validation before it can be used for individualised clinical decision-making.
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