Nomogram for prediction of lymph node metastasis in patients with superficial esophageal squamous cell carcinoma

Abstract

Background and Aim Knowledge of lymph node metastasis (LNM) status is crucial to determine whether patients with superficial esophageal squamous cell carcinoma (ESCC) can be cured with endoscopic resection alone, without the need for additional esophagectomy. The present study aimed to identify predictive factors and develop a prediction model for LNM in patients with superficial ESCC. Methods Clinicopathologic data from 501 patients with superficial ESCC treated with radical esophagectomy were reviewed. Stepwise logistic regression analysis determined the predictors of LNM. Using these predictors, a nomogram for predicting the risk of LNM was constructed and internally validated using a bootstrap resampling method. Results LNM rates of tumors invading the lamina propria, muscularis mucosa, and SM1 layers were 3.7%, 15.5%, and 40.7%, respectively. Deep tumor invasion depth, moderately or poorly differentiated histology, and lymphovascular invasion were independent predictors of LNM. ESCC with muscularis mucosa and SM1 invasion had odds ratios of 3.635 and 11.834, respectively, compared with that for ESCC confined to the lamina propria. Large tumor size (>2.0 cm) and presence of tumor budding showed borderline significance for LNM prediction. These five variables were incorporated into a nomogram. A constructed nomogram showed good calibration and good discrimination with an area under the receiver‐operating characteristic curve (area under the curve [AUC]) of 0.812. After bootstrapping, AUC was 0.811. Conclusions We developed a nomogram that can facilitate individualized prediction of risk of LNM in patients with superficial ESCC. This model can aid in decision‐making for the need for additional esophagectomy after endoscopic resection for superficial ESCC.

Retrospective analysis of predictive factors for lymph node metastasis in superficial esophageal squamous cell carcinoma

“…Some previous studies reported that LNM seemed to be correlated with tumor size and also these results had statistical significance in SESCC patients 26 – 29 . It can be concluded from our study that tumor size was significantly correlated with LNM in entire 520 patients and also identified as an important predictor of LNM.…”

“…It was previously reported that histological differentiation was a potential risk factor of LNM 26 , 28 , 35 . Consistently, we also found a significant association between tumor differentiation and LNM in the current study (Table 3 ).…”

Prognostic nomograms and risk-stratifying systems for predicting survival in patients with resected pT2-4aN0M0 esophageal carcinoma

“…Despite several previously reported predictive models (7,8,(13)(14)(15)(16)(17)(18)(19)(20), a nomogram for resected pT2-4aN0M0 EC from two large databases with long-term follow-up has not been established. In the study by Du et al (15), the authors reviewed data of 4,566 resected localized EC from the SEER database and developed a predictive nomogram.…”

Development and validation of a nomogram for prediction of cervical lymph node metastasis in middle and lower thoracic esophageal squamous cell carcinoma

“…Preoperative gastroscopy and standard contrast-enhanced CT were performed to determine the tumor location and maximum diameter of the tumor. The tumor location of the upper, middle, and lower was diagnosed when the upper end of the tumor was located 15–25, 25–30, or 30–45 cm from an upper incisor, respectively [ 11 ]. Considering that small tumors such as the T1 stage of ESCC may be difficult to detect in CT images, the gastroscopy was alone used to define the maximum diameter of tumor when CT was not available to detect the lesion.…”