Cancer Res Treat.  2013 Dec;45(4):285-294.

Nomogram to Predict Treatment Outcome of Fluoropyrimidine/Platinum-Based Chemotherapy in Metastatic Esophageal Squamous Cell Carcinoma

• Jung HA
• Adenis A
• Lee J
• Park SH
• Maeng CH
• Park S
• Ahn HK
• Shim YM
• Penel N
• Im YH

Abstract

PURPOSE
The degree of benefit from palliative chemotherapy differs widely among patients with metastatic esophageal squamous cell carcinoma (MESCC). The purpose of this study was to develop and validate a prognostic nomogram to predict survival and aid physicians and patients in the decision-making process regarding treatment options.
MATERIALS AND METHODS
Clinicopathologic variables and treatment outcomes of 239 patients who were diagnosed with MESCC and received either fluorouracil/cisplatin (FP) or capecitabine/cisplatin (XP) as first-line chemotherapy were reviewed. A nomogram was developed as a prognostic scoring system incorporating significant clinical and laboratory variables based on a multivariate Cox proportional hazards regression model. An independent series of 61 MESCC patients treated with FP served as an independent data set for nomogram validation.
RESULTS
No difference in response rate was observed between the FP group (44.8%) and the XP group (54.2%). Similarly, no significant differences in median progression-free survival and median overall survival were observed between regimen groups. Multivariate analysis showed that poor performance status (Eastern Cooperative Oncology Group [ECOG] status> or =2), weight loss (10% of the weight loss for 3 months), low albumin level (< or =3.5 g/dL), and absence of previous esophagectomy at the time of chemotherapy were significantly associated with low OS in both groups (p<0.05). Based on these findings, patients were classified into favorable (score, 0 to 90), intermediate (91-134), and poor (>135) prognostic groups. The median survival for those with a favorable ECOG was 13.8 months (95% confidence interval [CI], 10.8 to 18.6 months), for intermediate 11.2 months (95% CI, 8.7 to 11.9 months), and for poor, 7.0 months (95% CI, 3.6 to 10.0 months). External validation of the nomogram in a different patient cohort yielded significantly similar findings.
CONCLUSION
The nomogram described here predicts survival in MESCC patients and could serve as a guide for the use of FP/XP chemotherapy in MESCC patients.

Keyword

Esophageal squamous cell carcinoma; Prognostic factor; Nomograms

MeSH Terms

Carcinoma, Squamous Cell*
Cohort Studies
Dataset
Disease-Free Survival
Drug Therapy*
Esophagectomy
Humans
Multivariate Analysis
Nomograms*
Treatment Outcome*
Weight Loss

Figure

• 

  Fig. 1 Nomogram for overall survival. ECOG, Eastern Cooperative Oncology Group; OS, overall survival.

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  Fig. 2 Survival curve according to nomogram score. OS, overall survival; PFS, progression-free survival.

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  Fig. 3 (A) Receiver operating characteristic curve for 12-month overall survival. (B) Calibration curve for predicted 12-month survival probability. Axis X, predicted 12-month survival probability; axis Y, observed 12-month survival probability; dashed line, ideal reference line; solid line, current nomogram performance with 95% confidence intervals; circle, median observed survival probability; x, median observed survival probability after bias correction. ROC, receiver operating characteristic; OS, overall survival; XP, capecitabine/cisplatin; AUC, receiver operating characteristic curve; FP, fluorouracil/cisplatin.

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  Fig. 4 Survival curves (overall survival [OS] and progression-free survival [PFS]) according to the nomogram score in the validation set.

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