Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jan 28, 2024; 16(1): 9-19
Published online Jan 28, 2024. doi: 10.4329/wjr.v16.i1.9
Computed tomography-based nomogram of Siewert type II/III adenocarcinoma of esophagogastric junction to predict response to docetaxel, oxaliplatin and S-1
Chuan-Qinyuan Zhou, Dan Gao, Yan Gui, Ning-Pu Li, Wen-Wen Guo, Hai-Ying Zhou, Rui Li, Jing Chen, Xiao-Ming Zhang, Tian-Wu Chen
Chuan-Qinyuan Zhou, Dan Gao, Wen-Wen Guo, Hai-Ying Zhou, Rui Li, Xiao-Ming Zhang, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Yan Gui, Ning-Pu Li, Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Jing Chen, Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan Province, China
Tian-Wu Chen, Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Co-first authors: Chuan-Qinyuan Zhou and Dan Gao.
Author contributions: Chen TW, Gui Y and Zhang XM proposed the study; Zhou CQ, Gao D, Li NP, Guo WW, Zhou HY, Li R and Chen J performed the research and collected the data; Zhou CQ was responsible for patient screening, enrollment, collection of clinical and image data; Zhou CQ and Gao D measured the diameter of tumor, and Gao D divided the subjects according to the diameter changes of tumor; both authors have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; Zhou CQ and Chen TW analyzed the data and wrote the first draft; all authors contributed to the interpretation of the study and to further drafts; all authors read and approved the final manuscript; Chen TW is the guarantor.
Supported by the National Natural Science Foundation of China, No. 82271959, and the Nanchong-University Cooperative Research Project, No. 20SXQT0329.
Institutional review board statement: The study was reviewed and approved by the (Affiliated Hospital of North Sichuan Medical College) Institutional Review Board [(Approval No. 2023ER335-1)].
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: There are no conflicts of interest to declare in this study.
Data sharing statement: Please contact the corresponding author for data requests.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tian-Wu Chen, MD, Dean, Director, Doctor, Full Professor, Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing 400010, China. tianwuchen_nsmc@163.com
Received: October 4, 2023
Peer-review started: October 4, 2023
First decision: November 30, 2023
Revised: December 13, 2023
Accepted: January 8, 2024
Article in press: January 8, 2024
Published online: January 28, 2024
Processing time: 110 Days and 12.9 Hours
Abstract
BACKGROUND

Neoadjuvant chemotherapy (NAC) has become the standard care for advanced adenocarcinoma of esophagogastric junction (AEG), although a part of the patients cannot benefit from NAC. There are no models based on baseline computed tomography (CT) to predict response of Siewert type II or III AEG to NAC with docetaxel, oxaliplatin and S-1 (DOS).

AIM

To develop a CT-based nomogram to predict response of Siewert type II/III AEG to NAC with DOS.

METHODS

One hundred and twenty-eight consecutive patients with confirmed Siewert type II/III AEG underwent CT before and after three cycles of NAC with DOS, and were randomly and consecutively assigned to the training cohort (TC) (n = 94) and the validation cohort (VC) (n = 34). Therapeutic effect was assessed by disease-control rate and progressive disease according to the Response Evaluation Criteria in Solid Tumors (version 1.1) criteria. Possible prognostic factors associated with responses after DOS treatment including Siewert classification, gross tumor volume (GTV), and cT and cN stages were evaluated using pretherapeutic CT data in addition to sex and age. Univariate and multivariate analyses of CT and clinical features in the TC were performed to determine independent factors associated with response to DOS. A nomogram was established based on independent factors to predict the response. The predictive performance of the nomogram was evaluated by Concordance index (C-index), calibration and receiver operating characteristics curve in the TC and VC.

RESULTS

Univariate analysis showed that Siewert type (52/55 vs 29/39, P = 0.005), pretherapeutic cT stage (57/62 vs 24/32, P = 0.028), GTV (47.3 ± 27.4 vs 73.2 ± 54.3, P = 0.040) were significantly associated with response to DOS in the TC. Multivariate analysis of the TC also showed that the pretherapeutic cT stage, GTV and Siewert type were independent predictive factors related to response to DOS (odds ratio = 4.631, 1.027 and 7.639, respectively; all P < 0.05). The nomogram developed with these independent factors showed an excellent performance to predict response to DOS in the TC and VC (C-index: 0.838 and 0.824), with area under the receiver operating characteristic curve of 0.838 and 0.824, respectively. The calibration curves showed that the practical and predicted response to DOS effectively coincided.

CONCLUSION

A novel nomogram developed with pretherapeutic cT stage, GTV and Siewert type predicted the response of Siewert type II/III AEG to NAC with DOS.

Keywords: Esophagogastric junction; Adenocarcinoma; Neoadjuvant chemotherapy; Response; Tomography, X-ray computed; Predictor

Core Tip: We developed a computed-tomography-based nomogram with independent predictors including cT stage, gross tumor volume and Siewert type to predict the response of Siewert type II/III adenocarcinoma of the esophagogastric junction to neoadjuvant chemotherapy (NAC) with docetaxel, oxaliplatin and S-1 (DOS). The nomogram could predict subgroups of patients who would optimally benefit from NAC with DOS. Siewert type could be a novel predictor for response to NAC compared, which lays a foundation for follow-up studies.