Nomogram to Predict Treatment Outcome of Fluoropyrimidine/ Platinum-Based Chemotherapy in Metastatic Esophageal Squamous Cell Carcinoma
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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≥2), weight loss (10% of the weight loss for 3 months), low albumin level (≤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.
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≥2), weight loss (10% of the weight loss for 3 months), low albumin level (≤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.
참고문헌 (15)
- Enzinger PC, "Esophageal cancer", N Engl J Med, 349, pp.2241~2252 (2003)
- Gholipour C, "A histopathological study of esophageal cancer on the western side of the Caspian littoral from 1994 to 2003", Dis Esophagus, 21, pp.322~327 (2008)
- Jemal A, "Global cancer statistics", CA Cancer J Clin, 61, pp.69~90 (2011)
- Bouvier AM, "Management and prognosis of esophageal cancers: has progress been made", Eur J Cancer, 42, pp.228~233 (2006)
- Enzinger PC, ". Chemotherapy in esophageal cancer", Semin Oncol, 26(5 Suppl 15), pp.12~20 (1999)
- Bleiberg H, "Randomised phase II study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer", Eur J Cancer, 33, pp.1216~1220 (1997)
- Lee J, "Phase II study of capecitabine and cisplatin as first-line therapy in patients with recurrent or metastatic esophageal carcinoma", J Clin Oncol, 23(16S), pp.4221~ (2005)
- Conroy T, "Vinorelbine and cisplatin in metastatic squamous cell carcinoma of the oesophagus: response, toxicity, quality of life and survival", Ann Oncol, 13, pp.721~729 (2002)
- Ilson DH, "Phase II trial of paclitaxel, fluorouracil, and cisplatin in patients with advanced carcinoma of the esophagus", J Clin Oncol, 16, pp.1826~1834 (1998)
- Ilson DH, "Phase II trial of weekly irinotecan plus cisplatin in advanced esophageal cancer", J Clin Oncol, 17, pp.3270~3275 (1999)
- Mauer AM, "Phase II trial of oxaliplatin, leucovorin and fluorouracil in patients with advanced carcinoma of the esophagus", Ann Oncol, 16, pp.1320~1325 (2005)
- Adenis A, "Palliative chemotherapy does not improve survival in metastatic esophageal cancer", Oncology, 79, pp.46~54 (2010)
- Polee MB, "Prognostic factors for survival in patients with advanced oesophageal cancer treated with cisplatinbased combination chemotherapy", Br J Cancer, 89, pp.2045~2050 (2003)
- Chau I, "Multivariate prognostic factor analysis in locally advanced and metastatic esophago-gastric cancer: pooled analysis from three multicenter, randomized, controlled trials using individual patient data", J Clin Oncol, 22, pp.2395~2403 (2004)
- Grunberger B, "Palliative chemotherapy for recurrent and metastatic esophageal cancer", Anticancer Res, 27, pp.2705~2714 (2007)