Table_2_Clinical Characteristics, Prognosis, and Nomogram for Esophageal Cancer Based on Adenosquamous Carcinoma: A SEER Database Analysis.docx

Objective: Esophageal adenosquamous carcinoma (ASC) is a rare pathological type of cancer. Its clinical features and prognosis is poorly understood. The purpose of this study was to identify the characteristics of ASC patients and analyze the risk factors of esophageal carcinoma.
Methods: Patients with esophageal cancer in the SEER database diagnosed from 1975–2016 were obtained. The epidemiology, clinical characteristics, and outcomes between these three groups were compared. The nomogram and online dynamic nomogram were constructed according to the Cox proportional hazard model.
Results: The age-adjusted incidences of AC (1975–1999), AC (1999–2016), and ASC (1975–1989) increased over time (p < 0.05). Age-adjusted incidences of SqCC (1986–2012) and ASC (1989–2016) decreased (p < 0.05). Survival of patients with ASC was significantly worse when compared to AC and SqCC (ASC vs. AC, p < 0.001, ASC vs. SqCC, p = 0.01). ASC, older age, black race, male, overlapping site, higher tumor grade, lymph node metastasis, and a higher summary stage or AJCC stage were considered to be risk factors for a poor survival in the multivariate Cox analysis. The ROC curves and AUC indicated that the model has a good discrimination ability (AUC were 0.774 for a 3-year OS and 0.782 for a 5-year OS). An online dynamic nomogram was built based on the Cox proportional hazard model for convenient clinical use.
Conclusions: ASC is somewhat closer to AC rather than SqCC in terms of the demographics and tumor site, but has a worse OS than both AC and SqCC.

## 研究目的
食管腺鳞癌（Esophageal adenosquamous carcinoma, ASC）是一种罕见的恶性肿瘤病理类型，其临床特征与预后尚未得到充分阐明。本研究旨在明确食管腺鳞癌患者的临床特征，并分析食管癌的相关危险因素。

## 研究方法
本研究调取了SEER数据库中1975年至2016年确诊的食管癌患者数据，对比了三类患者的流行病学特征、临床资料与预后结局。基于Cox比例风险模型构建列线图（nomogram）与在线动态列线图。

## 研究结果
1975-1999年食管腺癌（Adenocarcinoma, AC）、1999-2016年食管腺癌以及1975-1989年食管腺鳞癌的年龄标化发病率随时间呈上升趋势（P<0.05）；而1986-2012年食管鳞状细胞癌（Squamous Cell Carcinoma, SqCC）及1989-2016年食管腺鳞癌的年龄标化发病率则随时间下降（P<0.05）。食管腺鳞癌患者的总体生存期（Overall Survival, OS）显著差于食管腺癌与食管鳞状细胞癌患者（食管腺鳞癌 vs 食管腺癌：P<0.001；食管腺鳞癌 vs 食管鳞状细胞癌：P=0.01）。多因素Cox比例风险模型分析显示，食管腺鳞癌、高龄、黑人种族、男性、肿瘤重叠部位、高肿瘤分级、淋巴结转移以及更高的总体分期或AJCC分期均为不良生存的独立危险因素。ROC曲线与曲线下面积（Area Under Curve, AUC）结果表明，该模型具有良好的区分效能：3年总生存期的AUC为0.774，5年总生存期的AUC为0.782。本研究基于Cox比例风险模型构建了在线动态列线图，以方便临床应用。

## 研究结论
食管腺鳞癌在人口统计学特征与肿瘤发病部位方面更接近于食管腺癌，而非食管鳞状细胞癌，但其总体生存期却显著差于食管腺癌与食管鳞状细胞癌。