Factors Affecting Long-Survival of Patients with Esophageal Cancer Using Non-Mixture Cure Fraction Model

The intra-class heterogeneity of immunophenotyping and immune landscape in oesophageal cancer and clinical implications

BACKGROUND

The response rate and survival benefit of immunotherapy vary among patients, implying specific immune status of an individual could be associated with the effect of immunotherapy. However, in-depth studies of immune subtypes (ISs), immune landscape and tumour microenvironment of oesophageal cancer (ESCA) and their clinical implications are less reported.

METHODS

We first accessed data from publicly available databases and preprocessed it based on a standard protocol. Then, ISs were identified by unsupervised learning. Thereafter, the association of these ISs and tumour mutation burden (TMB), biomarkers of chemotherapy-induced immune response, tumour markers were also assessed. In addition, the immune characteristics, immune landscape, co-expression network of immune genes, and clinical implications were visualized and analysed.

RESULTS

We identified three immunoclusters based on immune-associated genes with intra-class heterogeneity and prognostic value. Cluster-specific associations with TMB, markers of chemotherapy-induced immune response, and tumour markers were revealed. A 4-gene signature (risk score= -0.16514291×BHLHE22-0.03964046×MXRA8-0.15242778×SLIT2-0.05553572×SPON1) based on co-expressed genes in the immunoclusters was developed and externally validated.

CONCLUSIONS

In summary, we identified clinically relevant immunoclusters in both adenocarcinoma and squamous cell carcinoma of oesophagus, revealing the necessity of assessing the complexity and diversity of immune microenvironment for cancer immunotherapy.

Clinical characteristics and survival of 5283 esophageal cancer patients: A multicenter study from eighteen hospitals across six regions in China

Objective

This study aimed to investigate the potential determining epidemiological and clinical risk factors affecting the survival of esophageal cancer (EC) patients across multiple hospitals in China.

Methods

This was a multicenter study comprising of newly diagnosed EC cases from Beijing, Hebei, Henan, Hubei, Zhejiang, and Guangdong Province of China. Their baseline characteristics and treatment methods data were collected from their medical records. The EpiData software was used for data quality control. The Kaplan‐Meier method was used to estimate their overall survival (OS), and the Cox's proportional hazard regression model was used to estimate hazard ratios (HR) and 95% confidence interval (CI).

Results

The 3‐ and 5‐year OS rates of the 5283 investigated EC patients were 49.98% and 39.07%, respectively. Their median survival was 36.00 months. The median survival time of females was longer than that of males (females vs. males: 45.00 vs. 33.00, P < 0.001). The 5‐year OS rate of patients who never‐smoked was higher than that of smokers (never‐smokers vs smokers: 40.73% vs. 37.84%, P = 0.001). There was no significant difference in the 5‐year OS rate between drinkers and never‐drinkers (drinkers vs never‐drinkers: 34.22% vs. 29.65%, P = 0.330). In multivariate analysis, pathological stage (stage II: HR = 1.80, 95% CI = 1.40‐2.31; stage III: HR = 2.62, 95% CI = 2.06‐3.34; stage IV: HR = 3.90, 95% CI = 2.98‐5.09), poor differentiation/undifferentiated (HR = 1.34, 95% CI = 1.11‐1.63), not married status (HR = 2.45, 95% CI = 1.49‐4.04), production and service personnel (HR = 1.36, 95% CI = 1.01‐1.83) and farming/fishing (HR = 1.40, 95% CI = 1.12‐1.76) were independent prognostic risk factors for poor EC survival. Tumors in the thoracic or abdominal part of the esophagus, female and family history of any cancer were independent factors predictive of a good EC OS.

Conclusion

Gender, marital status, occupation, family history of any cancer, tumor topographical site, differentiation status, and pathological stage were associated with the survival rate of EC. This study reveals important clinical characteristics of esophageal cancer patients in China and provides helpful information for their clinical management and surveillance.