Year: 2023
Type: article
Study design: Observational Study
Abstract: This study aimed to identify the risk factors of lymph node metastasis (LNM) in superficial esophageal squamous cell carcinoma and use these factors to establish a prediction model.We retrospectively analyzed the data from training set (n = 280) and validation set (n = 240) underwent radical esophagectomy between March 2005 and April 2018.Our results of univariate and multivariate analyses showed that tumor size, tumor invasion depth, tumor differentiation and lymphovascular invasion were significantly correlated with LNM.Incorporating these 4 variables above, model A achieved AUC of 0.765 and 0.770 in predicting LNM in the training and validation sets, respectively.Adding macroscopic type to the model A did not appreciably change the AUC but led to statistically significant improvements in both the integrated discrimination improvement and net reclassification improvement.Finally, a nomogram was constructed by using these five variables and showed good concordance indexes of 0.765 and 0.770 in the training and validation sets, and the calibration curves had good fitting degree.Decision curve analysis demonstrated that the nomogram was clinically useful in both sets.It is possible to predict the status of LNM using this nomogram score system, which can aid the selection of an appropriate treatment plan.Abbreviations SESCC Superficial esophageal squamous cell carcinoma LNM Lymph node metastasis ER Endoscopic resection LVI Lymphovascular invasion AUC Area under the curve IDI Integrated discrimination NRI Net reclassification improvement DCA Decision curve analysisEsophageal cancer is the seventh most common malignancy in the world 1 .Esophageal squamous cell carcinoma confined to intraepithelial (Tis), mucosa (T1a) and submucosal (T1b), irrespective of lymph node metastasis (LNM), is considered to be superficial esophageal squamous cell carcinoma (SESCC) and have a good outcome 2 .Conventional view holds that the standard treatment for most esophageal cancers is radical esophagectomy, even for cancers confined to the mucosa 3 .However, this procedure has high rates of morbidity and mortality 4,5 .Furthermore, surgery may not be carried out in patients who are older or have multiple co-morbidities 6 .In order to reduce surgery-related complications and obtain a higher quality of post-operative life, currently a less invasive treatment method (such as endoscopic resection) has been considered as an alternative to esophageal surgery 7,8 .Nevertheless, SESCC has LNM potential because the lymphatic-capillary plexus in the mucosa of lamina propria and the submucosa of esophagus are plentiful.As a minimally invasive treatment and do not dissect lymph node, endoscopic resection (ER) is applied to SESCC without LNM.For SESCC with LNM, the proper
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
Funder: University of California, Davis
OpenAlex ID: W4380421512