Estimating Individualized Absolute Risk for Esophageal Squamous Cell Carcinoma: A Population-Based Study in High-Risk Areas of China

Shen, Yi; Xie, Shuanghua; Zhao, Lei; Song, Gonghua; Shao, Yi; Niu, Chen; Ruan, Xiaoli; Zang, Zhaoping; Nakyeyune, Rena; Liu, Fen; Wei, Wenqiang

doi:10.3389/fonc.2020.598603

Cited by 17 publications

(28 citation statements)

References 29 publications

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“…Chronic HP infection and increased intake of salted food increase the risk of stomach cancer [ 30 , 31 ]. Long‐term intake of hot food and tobacco smoking increase the risk of esophagus cancer [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Trends in cancer mortality in China from 2004 to 2018: A nationwide longitudinal study

Jiang

Zhang

Liu

et al. 2021

Cancer Communications

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Background: The long-term trend in cancer death in a rapidly developing country provides information for cancer prophylaxis. Here, we aimed to identify the trends in cancer mortality in China during the 2004-2018 period.Methods: Using raw data from the national mortality surveillance system of China, we assessed the mortalities of all cancer and site-specific cancers during the 2004-2018 period. The participants were divided into three age groups: ≥65 years, 40-64 years, and ≤39 years. Changing trends in cancer death by gender, residency, and tumor location were estimated using fitting joinpoint models to log-transformed crude mortality rates (CMRs) and age-standardized mortality rates (ASMRs).Results: Cancer death accounted for 24% of all-cause of death in China during 2014-2018. The CMR of all cancer was 150.0 per 100,000 persons. Cancer was the leading cause of death in the population <65 years. The six major cancer types (lung/bronchus cancer, liver cancer, stomach cancer, esophagus cancer, colorectal cancer, and pancreas cancer) accounted for 75.85% of all cancer deaths. The CMR of all cancer increased while the ASMR decreased during 2014-2018 (P < 0.001). Lung/bronchus cancer and liver cancer were the leading causes of cancer death in the population <65 years, accounting for 45.31% (CMR) and 44.35% (ASMR) of all cancer death, respectively. The ASMR of liver cancer was higher in the 40-64 years population than in the ≥65 years population, in contrast to the other five major cancers. The ASMRs of liver cancer, stomach cancer, and esophagus cancer decreased although they were higher in rural residents than in urban residents; the ASMRs of lung/bronchus cancer, colorectal cancer, and

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Section: Discussionmentioning

confidence: 99%

Trends in cancer mortality in China from 2004 to 2018: A nationwide longitudinal study

Jiang

Zhang

Liu

et al. 2021

Cancer Communications

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“…In contrast, about 60% of them showed a high ROB in the dominance of predictors as predictor assessments made with knowledge of the outcome, which resulted from case‐control study designs. The analysis criterion also showed a high ROB in all studies because of omitting missing data instead of performing imputation methods (n = 3) 18,22,23 or without any handling for missing data (n = 7) 9‐11,16,17,21,24 and inappropriate performance measures (n = 9) 9‐11,16‐21 . By applying PROBAST, all models were classified as having overall high ROB (Figure 2A).…”

Section: Resultsmentioning

confidence: 95%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Sun

Cao

et al. 2021

Cancer Medicine

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Background and aims Esophageal cancer risk prediction models allow for risk‐stratified endoscopic screening. We aimed to assess the quality of these models developed in the general population. Methods A systematic search of the PubMed and Embase databases from January 2000 through May 2021 was performed. Studies that developed or validated a model of esophageal cancer in the general population were included. Screening, data extraction, and risk of bias (ROB) assessment by the Prediction model Risk Of Bias Assessment Tool (PROBAST) were performed independently by two reviewers. Results Of the 13 models included in the qualitative analysis, 8 were developed for esophageal squamous cell carcinoma (ESCC) and the other 5 were developed for esophageal adenocarcinoma (EAC). Only two models conducted external validation. In the ESCC models, cigarette smoking was included in each model, followed by age, sex, and alcohol consumption. For EAC models, cigarette smoking and body mass index were included in each model, and gastroesophageal reflux disease, uses of acid‐suppressant medicine, and nonsteroidal anti‐inflammatory drug were exclusively included. The discriminative performance was reported in all studies, with C statistics ranging from 0.71 to 0.88, whereas only six models reported calibration. For ROB, all the models had a low risk in participant and outcome, but all models showed high risk in analysis, and 60% of models showed a high risk in predictors, which resulted in all models being classified as having overall high ROB. For model applicability, about 60% of these models had an overall low risk, with 30% of models of high risk and 10% of models of unclear risk, concerning the assessment of participants, predictors, and outcomes. Conclusions Most current risk prediction models of esophageal cancer have a high ROB. Prediction models need further improvement in their quality and applicability to benefit esophageal cancer screening.

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“…Several prediction models based on epidemiological variables have been proposed to identify high‐risk populations for ESCC screening [ 17 , 21 , 24 , 25 , 26 ]. Our model showed good discrimination in the independent external population, with an AUC of 0.80 (95% CI: 0.75–0.84) and good calibration (χ 2 = 9.43, P = 0.307 on the Hosmer‐Lemeshow test), suggesting the applicability of this model.…”

Section: Discussionmentioning

confidence: 99%

Improved esophageal squamous cell carcinoma screening effectiveness by risk‐stratified endoscopic screening: evidence from high‐risk areas in China

Ding

Zeng

et al. 2021

Cancer Communications

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Background Risk‐stratified endoscopic screening (RSES), which offers endoscopy to those with a high risk of esophageal cancer, has the potential to increase effectiveness and reduce endoscopic demands compared with the universal screening strategy (i.e., endoscopic screening for all targets without risk prediction). Evidence of RSES in high‐risk areas of China is limited. This study aimed to estimate whether RSES based on a 22‐score esophageal squamous cell carcinoma (ESCC) risk prediction model could optimize the universal endoscopic screening strategy for ESCC screening in high‐risk areas of China. Methods Eight epidemiological variables in the ESCC risk prediction model were collected retrospectively from 26,618 individuals aged 40‐69 from three high‐risk areas of China who underwent endoscopic screening between May 2015 and July 2017. The model's performance was estimated using the area under the curve (AUC). Participants were categorized into a high‐risk group and a low‐risk group with a cutoff score having sensitivities of both ESCC and severe dysplasia and above (SDA) at more than 90.0%. Results The ESCC risk prediction model had an AUC of 0.80 (95% confidence interval: 0.75–0.84) in this external population. We found that a score of 8 (ranging from 0 to 22) had a sensitivity of 94.2% for ESCC and 92.5% for SDA. The RSES strategy using this threshold score would allow 50.6% of endoscopies to be avoided and save approximately US$ 0.59 million compared to universal endoscopic screening among 26,618 participants. In addition, a higher prevalence of SDA (1.7% vs. 0.9%), a lower number need to screen (60 vs. 111), and a lower average cost per detected SDA (US$ 3.22 thousand vs. US$ 5.45 thousand) could have been obtained by the RSES strategy. Conclusions The RSES strategy based on individual risk has the potential to optimize the universal endoscopic screening strategy in ESCC high‐risk areas of China.

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Estimating Individualized Absolute Risk for Esophageal Squamous Cell Carcinoma: A Population-Based Study in High-Risk Areas of China

Cited by 17 publications

References 29 publications

Trends in cancer mortality in China from 2004 to 2018: A nationwide longitudinal study

Trends in cancer mortality in China from 2004 to 2018: A nationwide longitudinal study

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

Improved esophageal squamous cell carcinoma screening effectiveness by risk‐stratified endoscopic screening: evidence from high‐risk areas in China

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