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Establishment of prognostic models for adenocarcinoma of oesophagogastric junction patients with neoadjuvant chemoradiotherapy: a real-world study

Establishment of prognostic models for adenocarcinoma of oesophagogastric junction patients with neoadjuvant chemoradiotherapy: a real-world study

Authors :
Rongxu Du
Jiao Ming
Jianhao Geng
Xianggao Zhu
Yangzi Zhang
Shuai Li
Zhiyan Liu
Hongzhi Wang
Zhilong Wang
Lei Tang
Xiaotian Zhang
Aiwen Wu
Zhaode Bu
Yan Yan
Zhongwu Li
Yongheng Li
Ziyu Li
Weihu Wang
Source :
Radiation Oncology, Vol 17, Iss 1, Pp 1-10 (2022)
Publication Year :
2022
Publisher :
BMC, 2022.

Abstract

Abstract Background Multimodal therapies based on surgical resection have been recommended for the treatment of adenocarcinoma of the oesophagogastric junction (AEG). We aimed to evaluate prognostic factors in AEG patients receiving neoadjuvant chemoradiotherapy and to build predictive models. Methods T3 − T4N + M0 AEG patients with resectable Siewert type II/III tumours were enrolled in this study. All patients underwent neoadjuvant chemoradiation, followed by radical surgery or systemic therapy according to clinical response. Survival analysis was performed using the Kaplan–Meier method; multivariate analysis using the Cox proportional hazards method was also conducted. The Harrell concordance index (C-index) was used to test the prognostic value of models involving prognostic factors, and consistency between actual and predicted survival rates was evaluated by calibration curves. Results From February 2009 to February 2018, 79 patients were treated with neoadjuvant chemoradiotherapy; 60 patients of them underwent radical surgery. The R0 resection rate was 98.3%, and 46.7% of patients achieved a major pathologic response (MPR), namely, a residual tumour issue less than 10%. The 5-year overall survival (OS) rate was 63%, and the 5-year progression-free survival (PFS) rate was 48%. The incidence of grade 3 complications was 21.5%, and no grade 4 complications were reported. According to the results of univariate and multivariate analyses, we included the neutrophil–lymphocyte ratio (NLR), prognostic nutrition index (PNI), eosinophilic granulocyte (EOS) and postoperative pathologic stage in nomogram analysis to establish prediction models for OS and PFS; the C-index of each model was 0.814 and 0.722, respectively. Both the C-index and calibration curves generated to validate consistency between the actual and predicted survival indicated that the models were well calibrated and of good predictive value. Conclusions AEG patients achieved favourable downstaging and pathologic response after neoadjuvant chemoradiation, with acceptable adverse effects. Inflammation-based and nutrition-related factors and postoperative pathologic stage had a significant influence on OS and PFS, and the predictive value was verified through prognostic models.

Details

Language :
English
ISSN :
1748717X
Volume :
17
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Radiation Oncology
Publication Type :
Academic Journal
Accession number :
edsdoj.9f4be41423541cc89fa8c6e42f9cd60
Document Type :
article
Full Text :
https://doi.org/10.1186/s13014-022-02016-3