Goense et al reported a nomogram for evaluating a patient with esophageal adenocarcinoma prior to surgery. This can help to identify a patient who is likely to benefit from trimodality therapy (chemoradiotherapy followed by esophagectomy). The authors are from the University of Texas MD Anderson Cancer Center, University Medical Center Utrecht and Sun Yat-Sen University.
Patient selection: esophageal adenocarcinoma
Outcome: 1-year recurrence free survival (RFS)
Parameters:
(1) sex
(2) histologic grade (good, moderate or poor)
(3) signet ring cell adenocarcinoma
(4) clinical N stage
(5) baseline SUVmax on 18FDG-PET/CT scan
Parameter
Finding
Points
sex
female
0
male
100
histologic grade
good or moderate
0
poor
61.2
signet ring cell cancer
no
0
yes
71.8
clinical N stage
N0
0
N1
72.1
N2 or N3
96.5
baseline SUVmax
< 7
0
>= 7
71.2
score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 400.8
• The higher the score the worse the prognosis.
• A score < 276 is designated low risk and >= 276 as high risk.
• Trimodality therapy offers benefit in a low-risk patient.
Score
1-Year Recurrence Free Survival
< 32.8
> 95%
32.8 to 371.6
X = (3.3258 - (0.0097751 * (score));
probability = 1 / (1 + EXP((-1) * X))
> 371.6
< 40%
Performance:
• The area under the ROC curve is 0.66.
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