Can Lymphovascular Invasion be Predicted by Preoperative Contrast-Enhanced CT in Esophageal Squamous Cell Carcinoma?

Objective: To explore whether preoperative contrast-enhanced computed tomogrpahy (CT) can predict lymphovascular invasion (LVI) in esophageal squamous cell carcinoma (ESCC), and provide a reliable reference for the formulation of clinical individualized treatment plans. Methods: This retrospective study enrolled 228 patients with surgically resected and pathologically confirmed ESCC, including 36 patients with LVI and 192 patients without LVI. All patients underwent contrast-enhanced CT (CECT) scan within 2 weeks before the operation. Tumor size (including tumor length and maximum tumor thickness), tumor-to-normal wall enhancement ratio (TNR), and gross tumor volume (GTV) were obtained. All clinical features and CECT-derived parameters associated with LVI were analyzed by univariate and multivariate analysis. The independent predictors for LVI were identified, and their combination was built by multivariate logistic regression analysis, using the significant variables from the univariate analysis as inputs. Results: Univariate analysis of clinical features and CECT-derived parameters revealed that age, TNR, and clinical N stage (cN stage) were significantly associated with LVI. The multivariable analysis results demonstrated that age (odds ratio [OR]: 5.32, 95% confidence interval [CI]: 2.224-12.743, P<.001), TNR (OR: 5.399, 95% CI: 1.609-18.110, P = .006), and cN stage (cN1: OR: 2.874, 95% CI: 1.182-6.989, P = .02; cN2: OR: 6.876, 95% CI: 2.222-21.227) were identified to be independent predictors for LVI. The combination of age, TNR, and cN stage achieved a relatively higher area under the curve (AUC) (0.798), accuracy (ACC) (65.4%), sensitivity (SEN) (69.4%), specificity (SPE) (79.7%), positive predictive value (PPV) (77.4%), and negative predictive value (NPV) (71.6%). Conclusions: The combination of clinical features and CECT-derived parameters may be effective in predicting LVI status preoperatively in ESCC.