The Development of a Nomogram and the Prognostic Prediction Value of Patients With Esophageal Squamous Cell Carcinoma Undergoing Radical Radiotherapy

Figures & data

Table 1. Distribution of various factors in the training and verification cohorts.

Characteristic	Patients, n (%)	Training cohort (n = 141)	Validation cohort (n = 40)	p-value
Age (years)				0.316
≤66	110 (60.77)	83	27
>66	71 (39.23)	58	13
Sex				0.249
Male	123 (67.96)	111	12
Female	58 (32.04)	30	28
Smoking history				0.634
No	80 (44.2)	61	19
Yes	101 (55.8)	80	21
Drinking history				0.868
No	79 (43.65)	62	17
Yes	102 (56.35)	79	23
KPS score				0.357
70, 80	97 (53.59)	73	24
90	84 (46.41)	68	16
Localization				0.161
Cervical	20 (11.05)	16	4
Upper thoracic	70 (38.67)	59	11
Middle thoracic	77 (42.54)	56	21
Lower thoracic	14 (7.73)	10	4
Tumor length (cm)				0.280
<5.0	77 (42.54)	57	20
≥5.0	104 (57.46)	84	20
T stage				0.005
T2	13 (7.18)	6	7
T3	79 (43.65)	60	19
T4	89 (49.17)	75	14
N stage				0.553
N0	1 (0.55)	0	1
N1	67 (37.02)	53	14
N2	83 (45.86)	63	20
N3	30 (16.57)	25	5
TNM stage				0.052
II	8 (4.42)	4	4
III	173 (95.58)	137	36
RT dose (Gy)				0.652
<66	58 (32.04)	44	14
≥66	123 (67.96)	97	26
Chemotherapy				0.622
No	23 (12.71)	17	6
Yes	158 (87.29)	124	34
BMI (kg/m^2)				0.231
<21.13	80 (44.2)	59	21
≥21.13	101 (55.8)	82	19
PNI				0.255
<45.95	44 (24.31)	37	7
≥45.95	137 (75.69)	104	33
PLR				0.352
<217.2	134 (74.03)	121	13
≥217.2	47 (25.97)	20	27
SII				0.838
<1497	166 (91.71)	129	37
≥1497	15 (8.29)	12	3
CEI				0.631
<1729	46 (25.41)	37	9
≥1729	135 (74.59)	104	31
NLR				0.175
<4.84	150 (82.87)	114	36
≥4.84	31 (17.13)	27	4

CEI: Cervical esophageal carcinoma index; KPS: Karnofsky performance status; N: Node; NLR: Neutrophil to lymphocyte ratio; PLR: Platelet to lymphocyte ratio; PNI: Prognostic nutritional index; RT: Radiotherapy; SII: Systemic immunity inflammation index; T: Tumor; TNM: Tumor node metastasis.

Table 2. Univariate and multivariate analysis of prognostic factors for overall survival in the training cohort.

Characteristic	Univariate analysis		Multivariate analysis
	HR (95% CI)	p-value	HR (95% CI)	p-value
Age (years)
<67	1		1
≥67	2.044 (1.356–3.080)	0.001	1.990 (1.288–3.074)	0.002
Sex
Female	1		1
Male	0.775 (0.474–1.267)	0.310	–	–
Smoking history
No	1		1
Yes	1.044 (0.694–1.571)	0.835	–	–
Drinking history
No	1		1
Yes	1.269 (0.841–1.915)	0.257	–	–
KPS score
70–80	1		1
90	0.660 (0.436–0.997)	0.048	0.509 (0.330–0.785)	0.002
Localization
Cervical	1		1
Upper thoracic	1.212 (0.476–3.087)	0.687	–	–
Middle thoracic	0.881 (0.394–1.969)	0.757	–	–
Lower thoracic	0.847 (0.377–1.906)	0.689	–	–
Tumor length (cm)
<5.0	1		1
≥5.0	1.448 (0.953–2.202)	0.083	1.326 (0.822–2.136)	0.247
T stage
T2	1		1
T3	1.937 (0.596–6.292)	0.271	5.838 (1.628–20.929)	0.007
T4	2.879 (0.894–9.268)	0.076	7.672 (2.222–26.498)	0.001
N stage
N1	1		1
N2	0.968 (0.615–1.523)	0.888	0.952 (0.564–1.606)	0.853
N3	1.584 (0.914–2.742)	0.101	1.313 (0.68–2.535)	0.418
TNM stage
II	1		1
III	2.661 (0.653–10.853)	0.172	2.768 (0.219–34.897)	0.431
RT dose (Gy)
<66	1		1
≥66	0.991 (0.642–1.530)	0.969	–	–
Chemotherapy
No	1		1
Yes	0.425 (0.244–0.741)	0.003	0.471 (0.254–0.875)	0.017
BMI (kg/m^2)
<21.13	1		1
≥21.13	0.482 (0.319–0.727)	0.001	0.574 (0.376–0.878)	0.010
PNI
<45.95	1		1
≥45.95	0.567 (0.364–0.883)	0.012	0.989 (0.549–1.783)	0.971
PLR
<217.2	1		1
≥217.2	2.357 (1.381–4.022)	0.002	1.339 (0.606–2.96)	0.471
SII
<1497	1		1
≥1497	3.904 (2.040–7.470)	<0.001	1.221 (0.467–3.191)	0.684
CEI
<1729	1		1
≥1729	0.673 (0.432–1.047)	0.079	0.489 (0.293–0.819)	0.006
NLR
<4.84	1		1
≥4.84	2.384 (1.486–3.825)	<0.001	4.447 (2.555–7.739)	< 0.001

CEI: Cervical esophageal carcinoma index; HR: Hazard ratio; KPS: Karnofsky performance status; N: Node; NLR: Neutrophil to lymphocyte ratio; PLR: Platelet to lymphocyte ratio; PNI: Prognostic nutritional index; RT: Radiotherapy; SII: Systemic immunity inflammation index; T: Tumor; TNM: Tumor node metastasis.

Figure 1. Nomogram for predicting 1-year and 3-year overall survival of esophageal squamous cell carcinoma.

CEI: Cervical esophageal carcinoma index; KPS: Karnofsky performance status; NLR: Neutrophil to lymphocyte ratio; T: Tumor.

Figure 2. Calibration plot for the overall survival nomograms.

(A & B) Calibration curves of nomogram to (A) 1-year overall survival and (B) 3-year overall survival in the training cohort. (C & D) Calibration curves of nomogram to (C) 1-year overall survival and (D) 3-year overall survival in the verification cohort.

OS: Overall survival.

Figure 3. Receiver operating characteristic curve analysis of nomogram model, BMI, cervical esophageal carcinoma index and neutrophil to lymphocyte ratio.

(A) Receiver operating characteristic (ROC) curve analysis of the nomogram model for overall survival (OS) in patients with esophageal squamous cell carcinoma (ESCC) (AUC = 0.731). (B) ROC curve analysis of the BMI for OS in patients with ESCC (0.598). (C) ROC curve analysis of the neutrophil to lymphocyte ratio for OS in patients with ESCC (0.506). (D) ROC curve analysis of the cervical esophageal carcinoma index for OS in patients with ESCC (0.514).

AUC: Area under the curve.

Figure 4. Overall survival of included patients stratified according to the before-treatment nomogram model, BMI, cervical esophageal carcinoma index and neutrophil to lymphocyte ratio cutoff values.

The Kaplan–Meier curves and p-value represents the relationship between (A) overall survival (OS) and nomogram model (p < 0.001), (B) OS and BMI (p < 0.001), (C) OS and neutrophil to lymphocyte ratio (p < 0.001) and (D) OS and cervical esophageal carcinoma index (p = 0.077).