Nomogram for predicting pathologically complete response after neoadjuvant chemoradiotherapy for oesophageal cancer

Background A pathologically complete response (PCR) to neoadjuvant chemoradiotherapy (nCRT) is seen in 30% of the patients with oesophageal cancer. The aim is to identify patient and tumour characteristics associated with a PCR and to develop a nomogram for the prediction of PCR. Patients and methods Patients who underwent nCRT followed by surgery were identified and response to nCRT was assessed according to a modified Mandard classification in the resection specimen. A model was developed with age, gender, histology and location of the tumour, differentiation grade, alcohol use, smoking, percentage weight loss, Charlson Comorbidity Index (CCI), cT-stage and cN-stage as potential predictors for PCR. Probability of PCR was studied via logistic regression. Performance of the prediction nomogram was quantified using the concordance statistic (c-statistic) and corrected for optimism. Results A total of 381 patients were included. After surgery, 27.6% of the tumours showed a PCR. Female sex, squamous cell histology, poor differentiation grade, and low cT-stage were predictive for a PCR with a c-statistic of 0.64 (corrected for optimism). Conclusion A nomogram for the prediction of pathologically complete response after neoadjuvant chemoradiotherapy was developed, with a reasonable predictive power. This nomogram needs external validation before it can be used for individualised clinical decision-making.

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