Nomogram for Predicting Occult Locally Advanced Esophageal Squamous Cell Carcinoma Before Surgery

INTRODUCTION: The limitations of preoperative examination result in locally advanced esophageal squamous cell carcinoma (ESCC) often going undetected preoperatively. This study aimed to develop a clinical tool for identifying patients at high risk for occult locally advanced ESCC; the tool can be su...

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Detalles Bibliográficos
Autores principales: Huang, Zhixin, Hong, Zhinuan, Chen, Ling, Kang, Mingqiang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Surgery
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9237504/
https://www.ncbi.nlm.nih.gov/pubmed/35774392
http://dx.doi.org/10.3389/fsurg.2022.917070
Descripción
Sumario:INTRODUCTION: The limitations of preoperative examination result in locally advanced esophageal squamous cell carcinoma (ESCC) often going undetected preoperatively. This study aimed to develop a clinical tool for identifying patients at high risk for occult locally advanced ESCC; the tool can be supplemented with preoperative examination to improve the reliability of preoperative staging. MATERIALS AND METHODS: Data of 598 patients who underwent radical resection of ESCC from 2010 to 2017 were analyzed. Logistic multivariate analysis was used to develop a nomogram. The training cohort included patients who underwent surgery during an earlier period (n = 426), and the validation cohort included those who underwent surgery thereafter (n = 172), to confirm the model’s performance. Nomogram discrimination and calibration were evaluated using Harrell's concordance index (C-index) and calibration plots, respectively. RESULTS: Logistic multivariate analysis suggested that higher preoperative carcinoembryonic antigen levels (>2.43, odds ratio [OR]: 2.093; 95% confidence interval [CI], 1.233–2.554; P = 0.006), presence of preoperative symptoms (OR: 2.737; 95% CI, 1.194–6.277; P = 0.017), presence of lymph node enlargement (OR: 2.100; 95% CI, 1.243–3.550; P = 0.006), and advanced gross aspect (OR: 13.103; 95% CI, 7.689–23.330; P < 0.001) were independent predictors of occult locally advanced ESCC. Based on these predictive factors, a nomogram was developed. The C-indices of the training and validation cohorts were 0.827 and 0.897, respectively, indicating that the model had a good predictive performance. To evaluate the accuracy of the model, we divided patients into high-risk and low-risk groups according to their nomogram scores, and a comparison was made with histopathological data. CONCLUSION: The nomogram achieved a good preoperative prediction of occult locally advanced ESCC; it can be used to make rational therapeutic choices.

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