A validated nomogram integrating hematological indicators to predict response to neoadjuvant therapy in esophageal squamous cell carcinoma patients

Sichao Wang; Zihao Zhou; Dan Tian; Shujie Huang; Ce Wang; Zhen Gao; Xiaosong Ben; Jiming Tang; Liang Xie; Haiyu Zhou; Dongkun Zhang; Ruiqing Shi; Cheng Deng; Weitao Zhuang; Yu Ding; Guibin Qiao

doi:10.21037/atm-21-1628

A validated nomogram integrating hematological indicators to predict response to neoadjuvant therapy in esophageal squamous cell carcinoma patients

Ann Transl Med. 2021 Apr;9(8):703. doi: 10.21037/atm-21-1628.

Authors

Sichao Wang¹, Zihao Zhou¹, Dan Tian¹, Shujie Huang^{1

2}, Ce Wang³, Zhen Gao^{1

4}, Xiaosong Ben¹, Jiming Tang¹, Liang Xie¹, Haiyu Zhou¹, Dongkun Zhang¹, Ruiqing Shi¹, Cheng Deng¹, Weitao Zhuang^{1

2}, Yu Ding^{1

4}, Guibin Qiao¹

Affiliations

¹ Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² Shantou University Medical College, Shantou, China.
³ Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁴ The Second Clinical Medical School, Southern Medical University, Guangzhou, China.

Abstract

Background: The prognoses for advanced Esophageal squamous cell cancer (ESCC) was very poor. Neoadjuvant therapy was shown to improve overall survival of ESCC patients. However, there is still no effective indicator to predict the efficacy of neoadjuvant therapy. The present study intended to investigate the correlation between hematological parameters and the efficacy of neoadjuvant therapy so as to provide a reference for the prediction of cancer response to neoadjuvant therapy.

Methods: This study included 197 ESCC patients in our center from January 2010 to December 2018. Response evaluation criteria in solid tumors (RECIST) criteria were used for the treatment evaluation. The results of univariate and multivariate logistic regression analysis were used to select independent factors for construction of the prediction model. The concordance index (C-index), receiver operating characteristic (ROC) curve, and calibration curve were used to evaluate the robustness of the model, while the bootstrap method was used for internal validation.

Results: Among the 197 included ESCC patients, 94 patients achieved partial remission, 80 patients were in stable condition, and 23 patients had disease progression, 123 of whom underwent surgery. The comparisons of the dynamic hematological test results before and after treatment show that pre-PLT, pre-MONO%, post-Hb, △WBC, and the option of undergoing neoadjuvant chemoradiation were the potential predictors for the effectiveness of neoadjuvant therapy. The model in which the C-index was 0.803 (95% confidence interval: 0.742-0.864) showed good prediction performance, and still reach a C-index of 0.764 when internally validated.

Conclusions: For the neoadjuvant treatment of ESCC, hematological indexes are closely related to the efficacy of neoadjuvant therapy. The nomogram can be used to easily predict the efficacy of neoadjuvant therapy in patients.

Keywords: Esophageal squamous cell carcinoma (ESCC); hematology test; neoadjuvant therapy; nomogram; response prediction.