Multicenter retrospective study externally validates postoperative disease-free survival nomogram in esophageal squamous cell carcinoma

A multicenter retrospective cohort study involving 890 patients with esophageal squamous cell carcinoma who underwent surgery after neoadjuvant chemoimmunotherapy found that a clinicopathological nomogram predicted postoperative disease-free survival with a C-index of 0.701 in an external validation cohort. The findings, summarized in the study abstract, indicate that the model may complement ypTNM staging for postoperative risk stratification, although prospective validation is required before routine clinical use.

Researchers reviewed patients treated at four Chinese centers from October 2019 through December 2025. One center supplied a training cohort of 546 patients, while three independent centers supplied an external validation cohort of 344. Disease-free survival events occurred in 172 training participants and 93 external-validation participants. Predictors were selected using least absolute shrinkage and selection operator-penalized Cox regression and bootstrap stability selection. The resulting nomogram incorporated ypN stage, perineural invasion, major pathological response, ypT stage, sex, body mass index category and lymphovascular invasion.

The model’s discrimination was 0.741 (95% confidence interval, 0.702–0.780) in the training cohort and 0.701 (0.644–0.757) in external validation. Optimism-corrected C-indices were 0.726 (0.688–0.762) for fixed-model validation and 0.706 (0.668–0.747) when predictor selection was repeated. In the external cohort, the C-index difference between the nomogram and categorical ypTNM staging was 0.048 (0.014–0.082). External calibration showed reasonable agreement between predicted and observed disease-free survival at one and two years, but the model overpredicted disease-free survival at three years. Decision-curve analysis indicated greater net benefit than ypTNM staging within specified threshold ranges.

Using a fixed cutoff derived from the training cohort, patients classified as high risk had poorer disease-free survival in both the training cohort (hazard ratio, 3.86; 95% confidence interval, 2.75–5.44) and the external validation cohort (hazard ratio, 3.40; 95% confidence interval, 2.16–5.35; both P<0.001). The results support further evaluation of the nomogram for individualized postoperative risk estimates among patients with ESCC treated with neoadjuvant chemoimmunotherapy followed by surgery. Because the evidence presented here comes from a retrospective study and an early-access abstract, the reported performance does not establish clinical benefit, and prospective validation remains necessary.

Subject of Research: External validation of a postoperative disease-free survival prediction model in esophageal squamous cell carcinoma

Article Title: Development and external validation of a nomogram to predict disease-free survival after neoadjuvant chemoimmunotherapy and surgery in esophageal squamous cell carcinoma: a multicenter retrospective study

Article References: Ao, Y., Leng, C., Shao, L., Liu, G., Li, K., Chen, J., Huang, Y., Luo, K., Liu, Q., Zhao, L., Peng, S., & Fu, J. (2026). Development and external validation of a nomogram to predict disease-free survival after neoadjuvant chemoimmunotherapy and surgery in esophageal squamous cell carcinoma: a multicenter retrospective study. BMC Cancer. https://doi.org/10.1186/s12885-026-17164-y

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17164-y

Keywords: esophageal squamous cell carcinoma, neoadjuvant chemoimmunotherapy, esophagectomy, disease-free survival, prognostic nomogram, external validation, retrospective cohort, ypTNM staging, Development, external, validation, nomogram