Department of Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, 300060, China.
BMC Cancer. 2021 Apr 20;21(1):431. doi: 10.1186/s12885-021-08077-z.
A nomogram was developed to predict lymph node metastasis (LNM) for patients with early-stage esophageal squamous cell carcinoma (ESCC).
We used the clinical data of ESCC patients with pathological T1 stage disease who underwent surgery from January 2011 to June 2018 to develop a nomogram model. Multivariable logistic regression was used to confirm the risk factors for variable selection. The risk of LNM was stratified based on the nomogram model. The nomogram was validated by an independent cohort which included early ESCC patients underwent esophagectomy between July 2018 and December 2019.
Of the 223 patients, 36 (16.1%) patients had LNM. The following three variables were confirmed as LNM risk factors and were included in the nomogram model: tumor differentiation (odds ratio [OR] = 3.776, 95% confidence interval [CI] 1.515-9.360, p = 0.004), depth of tumor invasion (OR = 3.124, 95% CI 1.146-8.511, p = 0.026), and tumor size (OR = 2.420, 95% CI 1.070-5.473, p = 0.034). The C-index was 0.810 (95% CI 0.742-0.895) in the derivation cohort (223 patients) and 0.830 (95% CI 0.763-0.902) in the validation cohort (80 patients).
A validated nomogram can predict the risk of LNM via risk stratification. It could be used to assist in the decision-making process to determine which patients should undergo esophagectomy and for which patients with a low risk of LNM, curative endoscopic resection would be sufficient.
为预测早期食管鳞状细胞癌（ESCC）患者的淋巴结转移（LNM），我们开发了一种列线图模型。
我们使用了 2011 年 1 月至 2018 年 6 月期间接受手术的 T1 期疾病病理 ESCC 患者的临床数据来开发列线图模型。多变量逻辑回归用于确认变量选择的风险因素。基于列线图模型对 LNM 的风险进行分层。该列线图通过 2018 年 7 月至 2019 年 12 月期间接受食管癌切除术的早期 ESCC 患者的独立队列进行验证。
在 223 例患者中，有 36 例（16.1%）患者发生 LNM。以下三个变量被确认为 LNM 的风险因素，并被纳入列线图模型：肿瘤分化（优势比[OR] = 3.776，95%置信区间[CI] 1.515-9.360，p = 0.004）、肿瘤侵袭深度（OR = 3.124，95% CI 1.146-8.511，p = 0.026）和肿瘤大小（OR = 2.420，95% CI 1.070-5.473，p = 0.034）。在推导队列（223 例患者）中，C 指数为 0.810（95% CI 0.742-0.895），在验证队列（80 例患者）中为 0.830（95% CI 0.763-0.902）。
验证后的列线图可以通过风险分层预测 LNM 风险。它可用于协助决策过程，以确定哪些患者应接受食管癌切除术，以及对于 LNM 风险较低的患者，根治性内镜切除术就足够了。
