Selection of high‐risk individuals for esophageal cancer screening: A prediction model of esophageal squamous cell carcinoma based on a multicenter screening cohort in rural China

Abstract

The mortality benefit of esophageal squamous cell carcinoma (ESCC) screening has been reported in several studies; however, the results of ESCC screening programs in China are suboptimal. Our study aimed to develop an ESCC risk prediction model to identify high-risk individuals for population-based esophageal cancer screening. In total, 86 745 participants enrolled in a population-based esophageal cancer screening program in rural China between 2007 and 2012 were included in the present study and followed up until December 31, 2015. Models for identifying individuals at risk of ESCC within 3 years were created using logistic regressions. The area under the receiver operating curve (AUC) was determined to estimate the model's overall performance. A total of 298 individuals were diagnosed with ESCC within 3 years after baseline. The model of ESCC included the predictors of age, sex, family history of upper gastrointestinal cancer, smoking status, alarming symptoms of retrosternal pain, back pain or neck pain, consumption of salted food and fresh fruits and disease Abbreviations: +LR, positive likelihood ratio; AUC, area under the receiver operating curve; BMI, body mass index; CI, confidence interval; ESCC, esophageal squamous cell carcinoma; −LR, negative likelihood ratio; NNS, number needed to screen; NPV, negative predictive value; OR, odds ratio; PPV, positive predictive value; UGI, upper gastrointestinal. Wanqing Chen and He Li contributed equally to this study.

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

“…Table 2 shows the distribution of each risk factor of the developed ESCC prediction model in our study population. The study participants in our external validation were similar in age and sex distributions to those in the model development cohorts [ 21 ], but exhibited a higher prevalence of the other six risk factors.…”

“…The baseline questionnaire covered variables in the ESCC risk scoring system developed by Chen et al . [ 21 ], except for one subitem of unexplained neck pain which was included in the variable of nonspecific alarming symptoms. Cumulative scores ranging from 0 to 22 were derived for each participant using the scoring rule by Chen et al .…”

“…Cumulative scores ranging from 0 to 22 were derived for each participant using the scoring rule by Chen et al . [ 21 ].…”

“…Evidence of RSES in high‐risk areas of China is limited to the best of our knowledge, and no available assessment tool for risk‐stratified ESCC screening has been validated externally in the Chinese population. We previously developed a 22‐score ESCC risk prediction model based on a multicenter prospective cohort in a Chinese population to identify those with a high risk of ESCC for whom endoscopy was recommended [ 21 ]. This model included eight epidemiological variables of age, sex, family history of upper gastrointestinal (UGI) cancer, smoking status, consumption of salted food, consumption of fresh fruits, nonspecific alarming symptoms of retrosternal pain, back pain, or neck pain, and disease history of peptic ulcer or esophagitis, with the total ESCC risk score ranging from 0 to 22.…”

Identification of the Prognostic Value of Tumor Microenvironment-Related Genes in Esophageal Squamous Cell Carcinoma

“…Previous studies have established several molecular models to predict the long-term survival of patients with ESCC (Wen et al, 2014;Chen W. et al, 2020;. These studies often overlook the role of TME in ESCC.…”