3560 - Development and Analysis of a Nomogram Based on Prognostic Factors in Locally Advanced Esophagogastric Junction Adenocarcinoma Treated with Neoadjuvant Chemoradiotherapy

Purpose/Objective(s): This study aims to identify independent prognostic factors for patients with locally advanced adenocarcinoma of the esophagogastric junction (AEG) who have undergone neoadjuvant chemoradiotherapy (NCRT) and to construct a nomogram model to predict overall survival (OS) and progression-free survival (PFS). The performance of the nomogram, including its ability to discriminate and calibrate outcomes, will be evaluated to guide personalized treatment strategies for AEG patients.

Materials/Methods: We retrospectively analyzed the hematological parameters and clinicopathological characteristics of 103 patients with locally advanced AEG who received NCRT followed by surgery. Data were collected from the Fourth Hospital of Hebei Medical University from December 1, 2012, to December 1, 2020. A nomogram prediction model was constructed based on significant prognostic factors to predict the efficacy of treatment for AEG.

Results: A total of 103 patients with AEG who met the inclusion criteria were enrolled in this study. The pathological complete response (pCR) rate for the entire cohort was 27.3%. Univariate analysis revealed no significant associations between any of the investigated factors and the pathological complete response (pCR) rate in patients with adenocarcinoma of the AEG patients. The OS rates for the cohort at 1, 3, and 5 years were 96.1%, 74.8%, and 56.1%, respectively. Variables with P-values less than 0.2 in the univariate analysis were subsequently included in a multivariate logistic regression model. The results demonstrated that direct bilirubin (DBIL), prealbumin (PAB), and mean corpuscular hemoglobin concentration (MCHC) were independent prognostic factors for OS in AEG patients receiving NCRT. After internal validation, the concordance indices (C-indices) for the pCR, OS, and PFS prediction models were 0.724, 0.703, and 0.657, respectively. The area under the receiver operating characteristic curve (AUC) for the pCR rate was 0.722. The AUCs for the 3- and 5-year OS rates were 0.782 and 0.697, respectively, and the AUCs for the 3- and 5-year PFS rates were 0.686 and 0.611, respectively, suggesting good predictive performance of these models. The calibration curves showed good agreement with the ideal curves, and decision curve analysis demonstrated that the nomogram prediction models provided a superior net benefit for predicting survival outcomes.

Conclusion: Our findings suggest that DBIL, PAB, and MCHC may serve as independent risk factors for survival in patients with adenocarcinoma of the esophagogastric junction treated with NCRT. The resulting nomogram, based on these factors, provides a potentially useful tool for individualized prediction of survival benefits, which could contribute to the development of personalized treatment strategies for AEG.