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Thorac Cardiovasc Surg 2013; 61(06): 470-478
DOI: 10.1055/s-0032-1331843
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Prognostic Scoring System Predictive of Survival after Surgical Resection of Esophageal Carcinoma

Ines Gockel
1   Department of General, Visceral and Transplant Surgery, University Medical Center of Mainz, Germany, Mainz, Germany
,
Stefan Niebisch
1   Department of General, Visceral and Transplant Surgery, University Medical Center of Mainz, Germany, Mainz, Germany
,
Lynetta K. Campbell
2   Department of Statistics, Texas A&M University, Houston, Texas, USA
,
George Sgourakis
3   Department of General Surgery and Surgical Oncology Unit of “Korgialenio—Benakio,” Red Cross Hospital, Athens, Greece
,
Theodor Junginger
1   Department of General, Visceral and Transplant Surgery, University Medical Center of Mainz, Germany, Mainz, Germany
› Author Affiliations
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Publication History

29 July 2012

01 November 2012

Publication Date:
08 March 2013 (online)

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Abstract

Background The aim of our study was to develop a prognostic index score for patients undergoing surgical resection for esophageal cancer that accurately determines survival with specific clinicopathological characteristics.

Methods Clinical, histological, and demographical variables of 475 patients were entered in an univariate and multivariate regression model, followed by individual calculation of the Prognostic Indicator Score and model validation via simulation.

Results Significant variables included in the scoring system were number of positive lymph nodes, pT, pL, R, obesity, and American Society of Anesthesiologist classification. Survival probability and its associated hazard function was significantly different between the scores, with an increase of hazard ratio ranging from 2.56 (score 2) to 20 (score 6 or higher). Comparing histological cancer entities revealed statistical significance only between stage IIA versus IIB in squamous cell and stage IIIA versus IIIB in adenocarcinoma.

Conclusions According to our methodology, an individualized follow-up by each possible score might allow interdisciplinary selection of patients for treatments based on expected survival. This may represent a breakthrough in patient selection for currently available treatments and clinical studies.

Keywords

prognostic index score - esophageal cancer - surgical approach - operative - computing methodologies - model validation