Abstract
BackgroundDue to individualized conditions of lymph node metastasis (LNM) and distant metastasis (DM), the following therapeutic strategy and diagnosis of T1–2 esophageal cancer (ESCA) patients are varied. A prediction model for identifying risk factors for LNM, DM, and overall survival (OS) of high-risk T1–2 ESCA patients is of great significance to clinical practice.MethodsA total of 1,747 T1–2 ESCA patients screened from the surveillance, epidemiology, and end results (SEER) database were retrospectively analyzed for their clinical data. Univariate and multivariate logistic regression models were established to screen out risk factors for LNM and DM of T1-2 ESCA patients, while those of OS were screened out using the Cox regression analysis. The identified risk factors for LNM, DM, and OS were then subjected to the establishment of three nomograms, respectively. The accuracy of the nomograms was evaluated by depicting the calibration curve, and the predictive value and clinical utility were evaluated by depicting the clinical impact curve (CIC) and decision curve analysis (DCA), respectively.ResultsThe age, race, tumor grade, tumor size, and T-stage were significant factors for predicting LNM of T1–2 ESCA patients (p < 0.05). The age, T-stage, tumor grade, and tumor size were significant factors for predicting DM of T1–2 ESCA patients (p < 0.05). The age, race, sex, histology, primary tumor site, tumor size, N-stage, M-stage, and surgery were significant factors for predicting OS of T1–2 ESCA patients (p < 0.05). The C-indexes of the three nomograms constructed by these factors were 0.737, 0.764, and 0.740, respectively, suggesting that they were clinically effective.ConclusionsThe newly constructed nomograms can objectively and accurately predict the LNM, DM, and OS of T1–2 ESCA patients, which contribute to the individualized decision making before clinical management.
Highlights
Esophageal cancer is a common malignant tumor of the digestive tract, with about 572,000 new cases and 508,000 deaths in 2018
According to univariate and multivariate logistic regression models, lymph node metastasis (LNM) was found closely related to the age at diagnosis, race, tumor grade, tumor size, and T-stage, while it was not correlated with sex, primary site, and histology (Table 3)
T1–2 esophageal cancer (ESCA) patients with the oldest age (≥82 years) had a lowest risk of LNM (OR = 0.34, 95% CI = 0.22–0.52, p < 0.001), followed by those aged 68–81 years (OR = 0.65, 95% CI = 0.49–0.85, p = 0.002)
Summary
Esophageal cancer is a common malignant tumor of the digestive tract, with about 572,000 new cases and 508,000 deaths in 2018. Therapeutic strategies of ESCA are made according to individualized conditions of LNM and DM. Some gastroenterologists believed that T1–2 ESCA lesions do not break through the muscle layer, which are urgently resected under endoscopy. An early determination of LNM and DM of T1–2 ESCA patients based on their clinical data is beneficial to make individualized therapeutic strategies, reduce medical cost, and enhance the outcomes. Due to individualized conditions of lymph node metastasis (LNM) and distant metastasis (DM), the following therapeutic strategy and diagnosis of T1–2 esophageal cancer (ESCA) patients are varied. A prediction model for identifying risk factors for LNM, DM, and overall survival (OS) of high-risk T1–2 ESCA patients is of great significance to clinical practice
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