Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
The First Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu Province, China.
J Dig Dis. 2022 Apr;23(4):209-219. doi: 10.1111/1751-2980.13095.
In this study we aimed to predict the risk factors related to histopathologic upgrade after endoscopic submucosal dissection (ESD) in patients with pre-ESD esophageal squamous low-grade intraepithelial neoplasm (LGIN).
A training cohort of 201 patients with biopsy-confirmed esophageal squamous LGIN and underwent ESD at a tertiary medical center between January 2017 and July 2019 were included. Risk factors for histological upgrade were identified using the least absolute shrinkage and selection operator (LASSO) regression. A nomogram was then established. Internal validation was evaluated by discrimination, calibration plot, and decision-curve analysis. Another cohort of 48 patients were prospectively collected from July 2019 to June 2021 for external validation of the nomogram.
The rate of histological upgrade was 34.8% (70/201) and 27.1% (13/48) in the training and validation sets, respectively. LASSO regression identified that tumor area (mm ) per biopsy, Lugol's staining pattern, background coloration, and the circumferential range of the lesion were significantly associated with histological upgrade. The final nomogram attained favorable prediction efficacy in the training cohort (area under the receiver operating curve [AUROC] 0.96, 95% confidence interval [CI] 0.94-0.98) and validation cohort (AUROC 0.92, 95% CI 0.79 -0.99). This model generated well-fitted calibration and clinical-decision curves in both cohorts.
The nomogram may better guide clinical decision on whether performing EDS or follow-up for suspicious lesions in patients with biopsy-confirmed esophageal squamous LGIN.
本研究旨在预测内镜黏膜下剥离术（ESD）前食管鳞状低级别上皮内瘤变（LGIN）患者组织学升级的相关危险因素。
纳入 201 例经活检证实的食管鳞状 LGIN 并于 2017 年 1 月至 2019 年 7 月在一家三级医疗中心接受 ESD 的患者。使用最小绝对收缩和选择算子（LASSO）回归识别组织学升级的危险因素。然后建立了一个列线图。通过判别、校准图和决策曲线分析对内部验证进行评估。另一个队列的 48 例患者于 2019 年 7 月至 2021 年 6 月前瞻性收集，用于列线图的外部验证。
在训练组和验证组中，组织学升级的发生率分别为 34.8%（70/201）和 27.1%（13/48）。LASSO 回归确定肿瘤面积（mm ）/活检、卢戈氏染色模式、背景着色和病变的环周范围与组织学升级显著相关。最终的列线图在训练组中具有良好的预测效果（接收者操作特征曲线下面积[AUROC]0.96，95%置信区间[CI]0.94-0.98）和验证组（AUROC 0.92，95%CI 0.79-0.99）。该模型在两个队列中均生成了拟合良好的校准和临床决策曲线。
该列线图可更好地指导临床决策，即对于经活检证实的食管鳞状 LGIN 患者，是否行 ESD 或对可疑病变进行随访。
