Kazuki Sudo1, Xuemei Wang2, Lianchun Xiao2, Roopma Wadhwa1, Hironori Shiozaki1, Elena Elimova1, David C Rice3, Jeffrey H Lee4, Brian Weston4, Manoop S Bhutani4, Adarsh Hiremath5, Nikolaos Charalampakis1, Ritsuko Komaki6, Mariela A Blum1, Stephen G Swisher3, Dipen M Maru7, Heath D Skinner7, Jeana L Garris1, Jane E Rogers8, Wayne L Hofstetter3, Jaffer A Ajani1. 1. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas 3. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 4. Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas 5. Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 6. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas 7. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 8. Department of The University of Pharmacy Clinical Programs, Texas MD Anderson Cancer Center, Houston, Texas
Abstract
BACKGROUND: Among patients with localized esophageal cancer (LEC), 35% or more develop distant metastases (DM) as first relapse, most in the first 24 months after local therapy. Implementation of novel strategies may be possible if DM can be predicted reliably. We hypothesized that clinical variables could help generate a DM nomogram. PATIENTS AND METHODS: Patients with LEC who completed multimodality therapy were analyzed. Various statistical methods were used, including multivariate analysis to generate a nomogram. A concordance index (c-index) was established and validated using the bootstrap method. RESULTS: Among 629 patients analyzed (356 trimodality/273 bimodality), 36% patients developed DM as first relapse. The median overall survival from DM was only 8.6 months (95% CI, 7.0-10.2). In a multivariate analysis, the variables associated with a higher risk for developing DM were poorly differentiated histology (hazard ratio [HR], 1.76; P<.0001), baseline T3/T4 primary (HR, 3.07; P=.0006), and baseline N+ LEC (HR, 2.01; P<.0001). Although variables associated with a lower risk for DM were age of 60 years or older (HR, 0.75; P=.04), squamous cell carcinoma (HR, 0.54; P=.013), and trimodality therapy (HR, 0.58; P=.0001), the bias-corrected c-index was 0.67 after 250 bootstrap resamples. CONCLUSIONS: Our nomogram identified patients with LEC who developed DM with a high probability. The model needs to be refined (tumor and blood biomarkers) and validated. This type of model will allow implementation of novel strategies in patients with LEC.
BACKGROUND: Among patients with localized esophageal cancer (LEC), 35% or more develop distant metastases (DM) as first relapse, most in the first 24 months after local therapy. Implementation of novel strategies may be possible if DM can be predicted reliably. We hypothesized that clinical variables could help generate a DM nomogram. PATIENTS AND METHODS: Patients with LEC who completed multimodality therapy were analyzed. Various statistical methods were used, including multivariate analysis to generate a nomogram. A concordance index (c-index) was established and validated using the bootstrap method. RESULTS: Among 629 patients analyzed (356 trimodality/273 bimodality), 36% patients developed DM as first relapse. The median overall survival from DM was only 8.6 months (95% CI, 7.0-10.2). In a multivariate analysis, the variables associated with a higher risk for developing DM were poorly differentiated histology (hazard ratio [HR], 1.76; P<.0001), baseline T3/T4 primary (HR, 3.07; P=.0006), and baseline N+ LEC (HR, 2.01; P<.0001). Although variables associated with a lower risk for DM were age of 60 years or older (HR, 0.75; P=.04), squamous cell carcinoma (HR, 0.54; P=.013), and trimodality therapy (HR, 0.58; P=.0001), the bias-corrected c-index was 0.67 after 250 bootstrap resamples. CONCLUSIONS: Our nomogram identified patients with LEC who developed DM with a high probability. The model needs to be refined (tumor and blood biomarkers) and validated. This type of model will allow implementation of novel strategies in patients with LEC.
Authors: Lucas Goense; Peter S N van Rossum; Mian Xi; Dipen M Maru; Brett W Carter; Gert J Meijer; Linus Ho; Richard van Hillegersberg; Wayne L Hofstetter; Steven H Lin Journal: Ann Surg Oncol Date: 2018-03-22 Impact factor: 5.344
Authors: Lucas Goense; Jelle P Ruurda; Brett W Carter; Penny Fang; Linus Ho; Gert J Meijer; Richard van Hillegersberg; Wayne L Hofstetter; Steven H Lin Journal: Eur J Nucl Med Mol Imaging Date: 2018-04-16 Impact factor: 9.236