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Nutritional factors in predicting severe myelosuppression during concurrent chemoradiotherapy for esophageal cancer: development and internal validation of a pre-treatment nomogram

Year: 2026

Type: article

Abstract: Background: Esophageal cancer represents a common form of malignant neoplasm, with concurrent chemoradiotherapy constituting a standard therapeutic approach for locally advanced stages. However, the regimen's severe adverse effects limit the number of patients who can successfully undergo and complete the treatment. Therefore, this study seeks to examine the relationships between clinical factors and nutritional indicators in relation to myelosuppression during concurrent chemoradiotherapy. Additionally, it aims to develop a robust nomogram prediction model to facilitate early identification and preventive intervention for patients at high risk. Methods: A retrospective analysis was performed on 200 patients with esophageal cancer, including 198 treated at the Department of Radiotherapy, Fudan University Shanghai Cancer Center, from September 2020 to January 2023 and two treated at The People's Hospital of Bozhou, Anhui Province, between March 2024 and September 2025. Baseline clinical characteristics and hematological parameters prior to treatment were systematically collected, encompassing tumor stage, age, gender, surgical history, chemotherapy regimen, body mass index (BMI), peripheral blood prealbumin (PA), hemoglobin (Hb), Nutritional Risk Screening 2002 (NRS2002) score, and Prognostic Nutritional Index (PNI). These variables were subsequently subjected to least absolute shrinkage and selection operator (LASSO) regression and multivariate regression analyses to ascertain independent risk factors associated with severe bone marrow suppression (grades 3-4). A nomogram prediction model was developed based on these findings. Model performance was evaluated using discrimination, calibration, and decision curve analysis (DCA), with internal validation performed using 1,000 bootstrap resamples. Results: The incidence of severe myelosuppression (grades 3-4) among all patients was found to be associated with three independent factors: whether a concurrent TP (paclitaxel or nab-paclitaxel plus cisplatin) regimen is administered, Hb levels, and PNI. A nomogram was developed using the three predictors retained after LASSO selection and multivariable logistic regression: concurrent use of the TP regimen, Hb level, and PNI. The model demonstrated an area under the receiver operating characteristic (ROC) curve of 0.764. Calibration curves indicated a good fit with the standard curve, and DCA revealed substantial clinical benefit for the model at risk thresholds ranging from 0.26 to 0.94. Conclusions: A pretreatment nomogram for estimating the risk of severe myelosuppression was developed and internally validated using bootstrap resampling. Its generalizability and clinical utility require confirmation in independent external cohorts before clinical application.

Source: Translational Cancer Research

DOI: 10.21037/tcr-2026-1386

Authors: Zimu Li, Kuaile Zhao, Zhuting Tong

Institutions: Anhui Medical University, Bozhou People's Hospital, First Affiliated Hospital of Anhui Medical University, Fudan University, Fudan University Shanghai Cancer Center

Language: English

Topic: Esophageal Cancer Research and Treatment

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funder: Natural Science Foundation of Anhui Province