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A Novel Risk Stratification System for Primary Small-Cell Carcinoma of the Esophagus: Indication for Prognostication and Staging
30 Pages Posted: 19 Oct 2023
More...Abstract
Background: The prognosis of primary small cell carcinoma of the esophagus (PSCCE) is poor with marked diversity in survival outcomes. We aimed to develop anew risk stratification system (RSS) for PSCCE.
Methods: The study cohort consisted of PSCCE patients attending five medical institutions in China between 2008 and 2021, four of which were training set (n = 422) for the construction of the RSS, while the remaining one served as a separate cohort (n = 256) for the model validation. The RSS was established based on covariates associated with overall survival (OS) determined by multivariable analyses, two-sided P < ·05. Survival discrimination of RSS was assessed.
Findings: In training cohort, multivariate analysis revealed age, ECOG score, and initial lymph node metastasis were independent risk factors for OS in non-distant metastatic PESCC; concurrent hepatic metastasis was the only significantly detrimental factor for distant metastatic PESCC. Accordingly, RSS was developed and could classify patients into four subgroups: low-risk localized disease (LLD, non-distant metastasis PESCC without risk factors, n=58); high-risk localized disease (HLD, non-distant metastasis PESCC with ≥1 risk factor, n=199); low-risk metastatic disease (LMD, metastatic PESCC without concomitant liver metastases, n=103); and high-risk metastatic disease (HMD, metastatic disease with synchronous liver metastases, n=63). The 3-year OS rates were 52·5%, 29·5%, 14·4%, and 5·7% in LLD, HLD, LMD, and HMD, respectively. When compared with TNM system, RSS showed a consistently superior prediction of OS in both training and validation cohorts.
Interpretation: The RSS is a reliable stratification model for PESCC that could be recommended to optimize individualized treatments based on respective risks.
Funding: This work was supported by the Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University) and the Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies).
Declaration of Interest: The authors declare no competing financial interests.
Ethical Approval: The institutional review board approved the study and waived the need for informed consent, because the study does not include patient identification information.
Keywords: small cell carcinoma, esophagus, dichotomous staging, TNM staging, risk stratification system
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