Validation and update of a clinical score model to predict technical difficulty of colorectal endoscopic submucosal dissection: a multicenter prospective cohort study

Abstract

Background and AimsThe Zhongshan CR-ESD Score model was proposed to grade the technical difficulty of colorectal endoscopic submucosal dissection (CR-ESD). The objective of this study is to prospectively validate and update the score model. MethodsA multicenter prospective cohort analysis of CR-ESD was conducted. Individual data on patients, lesions, and outcomes of CR-ESD were utilized to validate the original model and further refine the difficulty prediction model. The data was randomly divided into discovery and internal validation cohorts. A multivariate Cox regression analysis was conducted on the discovery cohort to develop an updated risk-scoring system, which was then validated. ResultsA total of 548 patients with 565 colorectal lesions treated by ESD from 4 hospitals were included. In the prospective validation cohort, the area under the receiver operating characteristic (ROC) curve for the original model was 0.707. Six risk factors were identified and assigned point values: tumor size (2 points for 30-50 mm, 3 points for ≥50 mm), ≥ 2/3 circumference of the lesion (3 points), tumor location in the cecum (2 points) or flexure (2 points), LST-NG lesions (1 point), preceding biopsy (1 point), and NICE type3 (3 points). In the discovery cohort, the updated model had an area under the ROC curve of 0.738, while in the validation cohort it was 0.782. The cases were categorized into easy (score = 0-1), intermediate (score = 2-3), difficult (score = 4-6), and very difficult (score ≥7) groups. Satisfactory discrimination and calibration were observed. ConclusionsThe original model achieved an acceptable level of prediction in the prospective cohort. The updated model exhibited superior performance and can be used in place of the previous version.