A model for predicting individuals’ absolute risk of esophageal adenocarcinoma: Moving toward tailored screening and prevention

Abstract

Esophageal adenocarcinoma (EAC) is characterized by rapidly increasing incidence and poor prognosis, stressing the need for preventive and early detection strategies. We used data from a nationwide population-based case-control study, which included 189 incident cases of EAC and 820 age-and sex-matched control participants, from 1995 through 1997 in Sweden. We developed risk prediction models based on unconditional logistic regression. Candidate predictors included established and readily identifiable risk factors for EAC. The performance of model was assessed by the area under receiver operating characteristic curve (AUC) with cross-validation. The final model could explain 94% of all case patients with EAC (94% population attributable risk) and included terms for gastro-esophageal reflux symptoms or use of antireflux medication, body mass index (BMI), tobacco smoking, duration of living with a partner, previous diagnoses of esophagitis and diaphragmatic hernia and previous surgery for esophagitis, diaphragmatic hernia or severe reflux or gastric or duodenal ulcer. The AUC was 0.84 (95% confidence interval [CI] 0.81-0.87) and slightly lower after cross-validation. A simpler model, based only on reflux symptoms or use of antireflux medication, BMI and tobacco smoking could explain 91% of the case patients with EAC and had an AUC of 0.82 (95% CI 0.78-0.85). These EAC prediction models showed good discriminative accuracy, but need to be validated in other populations. These models have the potential for future use in identifying individuals with high absolute risk of EAC in the population, who may be considered for endoscopic screening and targeted prevention.The incidence of esophageal adenocarcinoma (EAC) has increased rapidly during the past four decades in many Western populations, including North America and Europe, with the highest incidence in the United Kingdom.1-3 There were 52 000 new patients with EAC (41 000 men and 11 000 women) worldwide in 2012. 4 The incidence of EAC has increased on average by 5% per year since 1970 in Sweden and even more so during the last 20 years. 1 EAC is also characterized by poor prognosis with an overall 5-year survival lower than 15%. Tumor stage at diagnosis is by far the strongest prognostic factor, 2,3,5 and detection at an early stage would possibly reduce the mortality.6-8 Endoscopy provides an opportunity of early detection of EAC or its premalignant condition, that is, Barrett's esophagus with dysplasia. However, universal endoscopic screening is not feasible or justified given the low absolute risk in the population, the risk of complications and the considerable costs. Identifying a limited group of individuals at high absolute risk of EAC for endoscopic screening is a more feasible strategy. Risk prediction modeling combining information on readily identifiable risk factors is a promising approach for selection of individuals with high absolute risk of EAC.9-12 Unfortunately, such prediction models have rarely been developed for EAC.Using data from a comprehensi...

Prediction of individuals at high absolute risk of esophageal squamous cell carcinoma

“…A more feasible way may be to identify a limited group of individuals with high absolute risk of ESCC, who might benefit from tailored endoscopic screening and surveillance. 2,9 By combining readily identifiable risk factors, risk prediction modeling is a promising tool for selecting individuals with high absolute cancer risk. [10][11][12] Yet, such prediction models have rarely been developed for ESCC, and none has been developed in a Western population.…”

External validation of a model to determine risk of progression of Barrett’s oesophagus to neoplasia

“…Multiple risk models have been derived (and some externally validated) for predicting Barrett's oesophagus and oesophageal adenocarcinoma . However, few models exist in the setting of risk prediction among patients with Barrett's oesophagus.…”

Candidate serum metabolite biomarkers for differentiating gastroesophageal reflux disease, Barrett’s esophagus, and high-grade dysplasia/esophageal adenocarcinoma

“…Preliminary risk models for BE or EA based on classic epidemiologic risk factors such as age, sex, BMI/WHR, smoking status, and GERD symptoms (53–56) have provided a promising starting point for improved risk stratification tools, but the modest classification accuracy of most models requires improvement to afford significant clinical utility. One emerging approach for enhancing non-invasive risk assessment is the Cytosponge, a cytological sampling device that yields esophageal epithelial cells for immunostaining or molecular analyses (57, 58).…”