Recurrence and prognostic model for identifying patients at risk for esophageal cancer after surgery

Objective: The aim of this study was to construct a risk model to assess overall survival (OS) and disease-free survival (DFS) in patients with esophageal cancer (EC) after surgery. Patients and methods: A total of 872 consecutive EC patients who had undergone surgery between February 2009 and October 2012 were retrospectively analyzed. The cutoff for risk value (RV) was inferred by receiver operating characteristic curves and the Youden index. A log-rank test was used to compare the survival curves, and a Cox regression analysis was performed to clarify the significant prognostic factors. Results: The area under the curve was 0.688 for OS and 0.645 for DFS. The survival rates were 69.4% (259/373) and 39.1% (195/499), and the rates of recurrence were 19.2% (70/364) and 27.6% (132/479), respectively, for RV<0.218 and RV >= 0.218 (chi(2) =78.83, P<0.001; chi(2) =9.07, P=0.003; respectively). A multivariate Cox regression analysis identified cases suffering from higher overall mortalities with RV >= 0.218 compared to RV<0.218 (HR=1.45; 95% CI, 1.21-2.02; P=0.015); similar results were also found for DES (HR=1.38; 95% CI, 1.03 1.86; P=0.033). Kaplan-Meier survival curves showed that cases with RV<0.218 had better OS and DFS than cases with RV >= 0.218 (log rank = 75.80, P<0.001; log rank = 24.78, P<0.001). Conclusion: This model could be applied to an integrated assessment of recurrence and prognostic risk alter the surgical treatment of EC.