AUTHOR=Huang Zhixin , Hong Zhinuan , Chen Ling , Kang Mingqiang 

TITLE=Nomogram for Predicting Occult Locally Advanced Esophageal Squamous Cell Carcinoma Before Surgery

JOURNAL=Frontiers in Surgery

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.917070

DOI=10.3389/fsurg.2022.917070

ISSN=2296-875X

ABSTRACT=<sec><title>Introduction</title><p>The limitations of preoperative examination result in locally advanced esophageal squamous cell carcinoma (ESCC) often going undetected preoperatively. This study aimed to develop a clinical tool for identifying patients at high risk for occult locally advanced ESCC; the tool can be supplemented with preoperative examination to improve the reliability of preoperative staging.</p></sec><sec><title>Materials and Methods</title><p>Data of 598 patients who underwent radical resection of ESCC from 2010 to 2017 were analyzed. Logistic multivariate analysis was used to develop a nomogram. The training cohort included patients who underwent surgery during an earlier period (<italic>n</italic> = 426), and the validation cohort included those who underwent surgery thereafter (<italic>n</italic> = 172), to confirm the model’s performance. Nomogram discrimination and calibration were evaluated using Harrell's concordance index (C-index) and calibration plots, respectively.</p></sec><sec><title>Results</title><p>Logistic multivariate analysis suggested that higher preoperative carcinoembryonic antigen levels (&gt;2.43, odds ratio [OR]: 2.093; 95% confidence interval [CI], 1.233–2.554; <italic>P </italic>= 0.006), presence of preoperative symptoms (OR: 2.737; 95% CI, 1.194–6.277; <italic>P </italic>= 0.017), presence of lymph node enlargement (OR: 2.100; 95% CI, 1.243–3.550; <italic>P </italic>= 0.006), and advanced gross aspect (OR: 13.103; 95% CI, 7.689–23.330; <italic>P </italic>&lt; 0.001) were independent predictors of occult locally advanced ESCC. Based on these predictive factors, a nomogram was developed. The C-indices of the training and validation cohorts were 0.827 and 0.897, respectively, indicating that the model had a good predictive performance. To evaluate the accuracy of the model, we divided patients into high-risk and low-risk groups according to their nomogram scores, and a comparison was made with histopathological data.</p></sec><sec><title>Conclusion</title><p>The nomogram achieved a good preoperative prediction of occult locally advanced ESCC; it can be used to make rational therapeutic choices.</p></sec>