AUTHOR=Huang Zhixin , Hong Zhinuan , Chen Ling , Kang Mingqiang 

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

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.917070

DOI=10.3389/fsurg.2022.917070

ISSN=2296-875X

ABSTRACT=Introduction. Limitations of preoperative examination result in advanced esophageal squamous cell carcinoma (ESCC) often going undetected preoperatively. This study aimed to develop a clinical tool for identifying patients at high risk of occult advanced ESCC, which 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 during 2010–2017 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 advance gross aspect (OR: 13.103; 95% CI: 7.689-23.330; P<0.001) were independent predictors of occult advanced ESCC. Based on these predictive factors, a nomogram was developed. 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 the nomogram score, which was compared to histopathological data.
Conclusion. The nomogram achieved a good preoperative prediction of occult advanced ESCC, which can lead to a rational therapeutic choice.