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

Abstract

Background Selection of high-risk subjects for endoscopic screening of esophageal squamous cell carcinoma (ESCC) lacks individual predictive tools based on environmental risk factors. Methods We 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. Results Most 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). Conclusions An 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.

Risk prediction models for esophageal cancer: A systematic review and critical appraisal

“…Table 1 summarizes the 13 prediction models’ major characteristics. Among them, nine were diagnostic models 9 , 10 , 11 , 16 , 17 , 18 , 19 , 20 , 21 and the other four were prognostic models. 12 , 22 , 23 , 24 Eight studies developed prediction models for ESCC, and the other five developed prediction models for EAC.…”

“…Missing predictor data existed in twelve models (92%); however, only two studies 12 , 19 handled the missing data by imputation procedures. Among the remaining ten models with missing predictors, three models 18 , 22 , 23 excluded missing predictor data from the multivariable regression, and seven models 9 , 10 , 11 , 16 , 17 , 21 , 24 did not report any techniques to handle missing data (Table S3 ). All publications employed discrimination methods to assess the prognostic utility of their model with the AUC.…”

“…However, the steps of evaluating the model performance of calibration were suboptimal. Half of the included studies (n = 7) 9 , 10 , 11 , 16 , 18 , 20 , 21 did not evaluate model fit through calibration methods. All models except one 21 were internally validated, and only two 22 , 24 were validated by an external population.…”

“…Tables 2 and 3 present the variables included in the prediction models of ESCC and EAC, respectively. Overall, the variables of ten models 9 , 10 , 11 , 12 , 17 , 20 , 21 , 22 , 23 , 24 were easily obtainable (via medical records or questionnaires), including demographic characteristics, lifestyle risk factors, family history of clinical cancer symptoms, medication use history, disease history, and surgical history. The other three models 16 , 18 , 19 further included genetic factors.…”

Development and Validation of an Esophageal Squamous Cell Carcinoma Risk Prediction Model for Rural Chinese: Multicenter Cohort Study

“…Endoscopy examination is one of the main inspection modality for ESCC or precursor lesion and endoscopic screening programs have been performed for high-risk populations across the world ( 8 , 9 ). Several screening programs for EC have been carried out in China, as follows: a community-based endoscopic screening for esophageal cancer for residents aged 25–65 years from six villages in Hua County, Henan Province, China which was carried out from 2007 ( 10 ); regional organized esophageal cancer screening programs since 2005 in endemic areas in China for 40–69-year-old adults ( 11 , 12 ); endoscopic screening for esophageal cancer in China (ESECC), a cluster RCT, carried out from January 2012 to September 2016 for people aged 45–69 years ( 13 , 14 ); “Taihang Anti-cancer Campaign” including three stations in Linxian in Henan Province, Cixian in Hebei Province and Yangchen in Shanxi Province for people aged ≥40 years old ( 15 ); a population-based case-control study from October 2010 to September 2013 in Taixing for participants aged 40–84 years ( 16 ); and the Esophageal, Stomach, Liver Cancer Screening Program (ESLCSP) carried out in four provinces: Jiangsu, Anhui, Shandong, and Henan in China for people aged 40 to 69 years ( 17 ). For people with special situations, such as, a history of head-and-neck cancers ( 18 , 19 ), high-risk population-tylosis, disease onset for Achalasia, injury history of caustic esophageal injury ( 11 ), and Barrett’s esophagus may be advised to have regular endoscopic examinations ( 8 , 20 ).…”