Work

Development and external validation of a nomogram for predicting survival in patients with esophageal adenosquamous carcinoma: a retrospective study of the SEER database and a Chinese multicenter registry

Year: 2025

Type: article

Abstract: BACKGROUND: Esophageal adenosquamous carcinoma (EASC)-a rare, aggressive esophageal cancer with poor prognosis-has no guideline-specified prognostic tools. Current models developed for pure adenocarcinoma or squamous-cell carcinoma may misclassify EASC risk. METHODS: We identified 551 eligible EASC cases in the SEER database (2000-2021) for the training cohort (n = 486) and consecutively enrolled 65 patients from two independent centres as an external validation cohort. Risk factors for overall survival were identified using LASSO cox regression analysis. A nomogram for both overall survival (OS) and cancer-specific survival (CSS) was then developed. Performance was evaluated using bootstrap-internal validation (1,000 resamples), time-dependent ROC curve, calibration curve and DCA, and was further externally validated. RESULTS: On multivariable cox analysis, older age (≥80 vs <60 years: HR 1.93, 95% CI 1.35-2.75, p < 0.001), advanced T stage (T4 vs T1: HR 2.13, 95% CI 1.41-3.22, p < 0.001)) and distant metastasis (M1 vs M0: HR 1.36, 95% CI 1.03-1.80, p = 0.030) were associated with increased mortality. Surgical resection (HR 0.33, 95% CI 0.23-0.46, p < 0.001) and chemotherapy (HR 0.41, 95% CI 0.31-0.53, p < 0.001) conferred significant survival benefits. The nomogram showed AUCs 0.80-0.87 at 1-, 3- and 5-year, good calibration and positive net benefit in both cohorts. CONCLUSION: The dual OS/CSS nomograms enable individualized EASC risk counselling. Prospective, multi-ethnic validation and assessment of decision impact are needed before clinical deployment.

Source: International Journal of Surgery

DOI: 10.1097/js9.0000000000004283

Authors: Zhi-Chen Xu, Bao-An Su, Jian-Cheng Li, Ju-Hui Chen

Institutions: Fujian Medical University, Fujian Provincial Cancer Hospital

Language: English

Topic: Esophageal Cancer Research and Treatment

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,450