SOURCE: Prediction Models for Overall Survival in Patients With Metastatic and Potentially Curable Esophageal and Gastric Cancer

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  • 1 Department of Medical Oncology, Cancer Center Amsterdam, and
  • 2 Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam;
  • 3 Department of Medical Oncology, University Medical Center Utrecht, Utrecht;
  • 4 Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam;
  • 5 Department of Surgery, Radboud University Medical Center, Nijmegen;
  • 6 Department of Medical Oncology, Leiden University Medical Center, Leiden;
  • 7 Department of Medical Oncology, Elisabeth Tweesteden Hospital, Tilburg;
  • 8 Department of Radiotherapy, Verbeeten Institute, Tilburg;
  • 9 Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam;
  • 10 Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht; and
  • 11 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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Background: Personalized prediction of treatment outcomes can aid patients with cancer when deciding on treatment options. Existing prediction models for esophageal and gastric cancer, however, have mostly been developed for survival prediction after surgery (ie, when treatment has already been completed). Furthermore, prediction models for patients with metastatic cancer are scarce. The aim of this study was to develop prediction models of overall survival at diagnosis for patients with potentially curable and metastatic esophageal and gastric cancer (the SOURCE study). Methods: Data from 13,080 patients with esophageal or gastric cancer diagnosed in 2015 through 2018 were retrieved from the prospective Netherlands Cancer Registry. Four Cox proportional hazards regression models were created for patients with potentially curable and metastatic esophageal or gastric cancer. Predictors, including treatment type, were selected using the Akaike information criterion. The models were validated with temporal cross-validation on their C-index and calibration. Results: The validated model’s C-index was 0.78 for potentially curable gastric cancer and 0.80 for potentially curable esophageal cancer. For the metastatic models, the c-indices were 0.72 and 0.73 for esophageal and gastric cancer, respectively. The 95% confidence interval of the calibration intercepts and slopes contain the values 0 and 1, respectively. Conclusions: The SOURCE prediction models show fair to good c-indices and an overall good calibration. The models are the first in esophageal and gastric cancer to predict survival at diagnosis for a variety of treatments. Future research is needed to demonstrate their value for shared decision-making in clinical practice.

Submitted May 18, 2020; accepted for publication July 30, 2020. Published online February 26, 2021.

Author contributions: Study concept and design: van den Boorn, Abu-Hanna, Sprangers, Zwinderman, van Laarhoven. Data acquisition, analysis, or interpretation: All authors. Statistical analysis: van den Boorn, Verhoeven, Zwinderman, van Laarhoven. Drafting of manuscript: van den Boorn, Abu-Hanna, Sprangers, Zwinderman, van Laarhoven. Critical revision: All authors. Administrative, technical, or material support: Abu-Hanna, Haj Mohammad, Hulshof, Gisbertz, Klarenbeek, Slingerland, Beerepoot, Rozema, Sprangers, Verhoeven, van Oijen, Zwinderman, van Laarhoven. Supervision: Abu-Hanna, Sprangers, Zwinderman, van Laarhoven. Obtained funding: van Laarhoven.

Disclosures: Dr. Abu-Hanna has disclosed that he is a consultant/adviser for ExpertDoc. Dr. Haj Mohammad has disclosed that she receives grant/research support from Servier, and consulting fees from Bristol-Myers Squibb Brazil, Celgene, Lilly, and Merck Sharp & Dohme. Dr. Verhoeven has disclosed that he receives grant/research support from Bristol-Myers Squibb. Dr. van Oijen has disclosed that he receives grant/research support from Amgen, Lilly, Nordic Bioscience, Roche, and Servier. Dr. van Laarhoven has disclosed that she receives honoraria from Lilly/ImClone; grant/research support from Bayer Schering Pharma, Bristol-Myers Squibb, Celgene, Janssen-Cilag, Lilly, Merck Sharp & Dohme, Nordic Group, Philips Healthcare, Roche, and Servier; consulting fees from AstraZeneca; and is a consultant/adviser for Bristol-Myers Squibb, Lilly/ImClone, Nordic Group, and Servier. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported by the Dutch Cancer Society (UVA 2014-7000).

Disclaimer: The funder had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Correspondence: Hanneke W.M. van Laarhoven, MD, PhD, PhD, Department of Medical Oncology, Amsterdam University Medical Centers, Meibergdreef 9; F4-224, 1105 AZ Amsterdam, the Netherlands. Email: h.vanlaarhoven@amsterdamumc.nl

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