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Radiation Oncology
Published in: Radiation Oncology 1/2019

Open Access 01-12-2019 | Esophageal Cancer | Research

Development and validation of a risk prediction model for radiotherapy-related esophageal fistula in esophageal cancer

Authors: Yiyue Xu, Linlin Wang, Bo He, Wanlong Li, Qiang Wen, Shijiang Wang, Xindong Sun, Xue Meng, Jinming Yu

Published in: Radiation Oncology | Issue 1/2019

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Abstract

Objectives

We aimed to identify the risk factors and provide a nomogram for the prediction of radiotherapy-related esophageal fistula in patients with esophageal cancer (EC) using a case-control study.

Patients and methods

Patients with esophageal fistula who received radiotherapy or chemoradiotherapy between 2003 and 2017 were retrospectively collected in two institutions. In the training cohort (TC), clinical, pathologic, and serum data of 136 patients (cases) who developed esophageal fistula during or after radiotherapy were enrolled and compared with 272 controls (1:2 matched with the diagnosis time of EC, sex, marriage, and race). After the univariable and multivariable logistic regression analyses, the independent risk factors were identified and incorporated into a nomogram. Then the nomogram for the risk prediction was externally validated in the validation cohort (VC; 47 cases and 94 controls) using bootstrap resampling.

Results

Multivariable analyses demonstrated that ECOG PS, BMI, T4, N2/3 and re-radiotherapy were independent factors for esophageal fistula. Then a nomogram was constructed with the C-index of 0.805 (95% CI, 0.762–0.848) for predicting the risk of developing esophageal fistula in EC patients receiving radiotherapy. Importantly, the C-index maintained 0.764 (95% CI, 0.683–0.845) after the external validation.

Conclusions

We created and externally validated the first risk nomogram of esophageal fistula associated with radiotherapy. This will aid individual risk stratification of patients with EC developing esophageal fistula.
Appendix
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Metadata
Title
Development and validation of a risk prediction model for radiotherapy-related esophageal fistula in esophageal cancer
Authors
Yiyue Xu
Linlin Wang
Bo He
Wanlong Li
Qiang Wen
Shijiang Wang
Xindong Sun
Xue Meng
Jinming Yu
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-019-1385-y

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