Background: Esophageal squamous cell carcinoma (ESCC) is an aggressive malignancy with rapid disease progression, even after radical surgical resection. The prognostic factors contributing to disease progression in ESCC patients have not yet been well understood.
Objectives: To determine the prognostic factors of recurrence-free survival (RFS) for Chinese ESCC patients after R0 esophagectomy.
Methods: This is a retrospective cohort study of patients undergoing R0 esophagectomy for SCC at a top tertiary hospital in China between 2013 and 2020. Patients’ demographic, clinical, surgical, pathological and follow-up data were retrieved from a prospectively maintained database. Univariate and multivariable Cox proportional hazards model, Stepwise Cox model, and Least Absolute Shrinkage and Selection Operator (LASSO)-Cox model were applied to evaluate prognostic factors. Models were evaluated by proportional hazard assumptions and deviance residuals. Concordance Index (C-index) was calculated to evaluate model performance.
Results: In total, 523 SCC patients were identified and 312 (60.0%) had suffered recurrence or death during a median follow-up of 4.15 years (interquartile range: 2.92-4.73 years). Univariate and multivariable Cox model identified five factors significantly contribute to RFS: Eastern Cooperative Oncology Group (ECOG) score 1 (Hazard Ratio [HR] 1.43, 95% CI: 1.08-1.80), upper location (HR 1.96, 95% CI: 1.10-3.30), tumor size≥3.5cm (HR 1.30, 95% CI: 1.01-1.56), pT3 stage (HR 1.57, 95% CI: 1.08-2.28) and pN+ stage (HR 1.80, 95% CI: 1.14-2.26). Stepwise Cox model yielded six factors: ECOG score 1 (HR 1.41, 95% CI: 1.01-1.87), smoking history (HR 1.24, 95% CI: 1.00-1.57), upper location (HR 1.87, 95% CI: 1.12-3.12), pT3 stage (HR 1.53, 95% CI: 1.05-2.22), pN+ stage (HR 1.65, 95% CI: 1.18-2.31), and tumor size ≥3.5cm (HR 1.32, 95% CI: 1.03-1.69). LASSO-Cox model yielded five factors after a 100-fold cross-validation: pT3 stage (HR 1.96, 95% CI: 1.37-2.81), pN+ stage (HR 1.76, 95% CI: 1.38-2.23), tumor size≥3.5cm (HR 1.25, 95% CI: 1.01-1.59), alcohol (HR 1.25, 95% CI: 1.01-1.57) and hospitalization days (HR 1.25, 95% CI: 1.00-1.57). Three Cox models all satisfied the proportional hazard assumptions and deviance residuals. C-indexes were 0.54 (95%CI, 0.46-0.63) for multivariable Cox, 0.64 (95%CI, 0.52-0.73) for Stepwise Cox and 0.67 (95%CI, 0.57-0.77) for LASSO-Cox model, respectively.
Conclusions: Larger tumor size, advanced T and N stage are consistently represented the significant prognostic factors for RFS across the three Cox regression models among Chinese ESCC patients after R0 esophagectomy. Other prognostic factors were inconsistent but may potentially contribute to the RFS.
.jpg "Qingqing Hu, PhD photo")
