A nomogram for screening esophageal squamous cell carcinoma based on environmental risk factors in a high-incidence area of China: a population-based case-control study

Xiaorong Yang,Chen Suo,Weimin Ye,Hui Chen,Ziyu Yuan,Jinyu Man,Jingru Yu,Li Jin,Xingdong Chen,Ming Lu,Xiaolin Yin,Tongchao Zhang

doi:10.1186/s12885-021-08053-7

Abstract

BackgroundSelection of high-risk subjects for endoscopic screening of esophageal squamous cell carcinoma (ESCC) lacks individual predictive tools based on environmental risk factors.MethodsWe performed a large population-based case-control study of 1418 ESCC cases and 1992 controls in a high-risk area of China. Information on potential risk factors was collected via face-to-face interview using an electronic structured questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models, and predictive nomograms were established accordingly. A weighted analysis was further conducted to introduce age into predictive nomograms due to frequency matching study design.ResultsMost cases were usually exposed to 4 to 6 risk factors, but most controls were usually exposed to 3 to 5 risk factors. The AUCs of male and female predictive nomograms were 0.75 (95%CI: 0.72, 0.77) and 0.76 (95%CI: 0.73, 0.79), respectively. The weighted analysis adding age in the predictive model improved the AUC in both men and women (0.81 (95%CI: 0.79, 0.84) and 0.88 (95%CI: 0.85, 0.90), respectively).ConclusionsAn easy-to-use preclinical predictive tool is provided to select candidate population with high ESCC risk for endoscopic screening. Its usefulness needs to be further evaluated in future screening practice.

Highlights

Selection of high-risk subjects for endoscopic screening of esophageal squamous cell carcinoma (ESCC) lacks individual predictive tools based on environmental risk factors
International Agency for Research on Cancer estimated that the global number of new esophageal cancer cases increased from 456,000 in 2012 to 572,034 in 2018 [1, 2], and esophageal squamous cell carcinoma (ESCC), main histopathologic subtype accounting for about 88% of esophageal cancer, remains the greatest cancer burden in some high-risk areas [3]
The current guideline is that those having Condition 1 and any one of Conditions 2–6 should be included in high-risk group and subjected to endoscopic screening: 1) Over 40 years old; 2) From high incidence areas of esophageal cancer; 3) With upper gastrointestinal symptoms; 4) Family history of esophageal cancer; 5) With esophageal diseases; 6) With other risk factors for esophageal cancer

Summary

Introduction

Selection of high-risk subjects for endoscopic screening of esophageal squamous cell carcinoma (ESCC) lacks individual predictive tools based on environmental risk factors. Most ESCC patients are diagnosed in late-stage and have a grim prognosis with 5-year overall survival rate of less than 25% [5, 6]. A considerable number of early stage ESCC patients have been identified and treated with improved prognosis via the project [10, 11], less than 0.5% diagnosis rate of ESCC among all endoscopically screened populations implicates a huge waste of medical resources and low compliance in screening due to lack of a relatively accurate selection algorithm of high-risk populations [12]. A quantitative prediction model which can output individual ESCC risk score will hopefully help risk-stratify population for targeted endoscopic screening [14]

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Conclusion