Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2023; 29(47): 6138-6147
Published online Dec 21, 2023. doi: 10.3748/wjg.v29.i47.6138
Risk factors and a predictive nomogram for lymph node metastasis in superficial esophageal squamous cell carcinoma
Jin Wang, Xian Zhang, Tao Gan, Ni-Ni Rao, Kai Deng, Jin-Lin Yang
Jin Wang, Tao Gan, Kai Deng, Jin-Lin Yang, Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Xian Zhang, Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Ni-Ni Rao, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610064, Sichuan Province, China
Author contributions: Wang J and Deng K designed and performed the research; Wang J, Zhang X and Gan T collected and analyzed the data; Wang J and Zhang X wrote the manuscript; Deng K, Rao NN and Yang JL supervised the report and revised the manuscript.
Supported by the National Natural Science Foundation of China, No. 82173253; the Sichuan Province Science and Technology Support Program, No. 2022YFH0003 and No. 2023NSFSC1900; the Postdoctoral Research Foundation of West China Hospital, No. 2021HXBH020; and the Medico- Engineering Cooperation Funds from the University of Electronic Science and Technology of China and West China Hospital of Sichuan University, No. HXDZ22005.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of West China Hospital of Sichuan University, approval No. 2015(159).
Informed consent statement: All study participants who underwent esophagectomy were provided informed written consent prior to surgery.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Lin Yang, MD, PhD, Chief Physician, Professor, Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu 610041, Sichuan Province, China. yangjinlin@wchscu.cn
Received: August 4, 2023
Peer-review started: August 4, 2023
First decision: October 25, 2023
Revised: November 7, 2023
Accepted: December 8, 2023
Article in press: December 8, 2023
Published online: December 21, 2023
Abstract
BACKGROUND

Superficial esophageal squamous cell carcinoma (ESCC) is defined as cancer infiltrating the mucosa and submucosa, regardless of regional lymph node metastasis (LNM). Endoscopic resection of superficial ESCC is suitable for lesions that have no or low risk of LNM. Patients with a high risk of LNM always need further treatment after endoscopic resection. Therefore, accurately assessing the risk of LNM is critical for additional treatment options.

AIM

To analyze risk factors for LNM and develop a nomogram to predict LNM risk in superficial ESCC patients.

METHODS

Clinical and pathological data of superficial ESCC patients undergoing esophagectomy from January 1, 2009 to January 31, 2016 were collected. Logistic regression analysis was used to predict LNM risk factors, and a nomogram was developed based on risk factors derived from multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was used to obtain the accuracy of the nomogram model.

RESULTS

A total of 4660 patients with esophageal cancer underwent esophagectomy. Of these, 474 superficial ESCC patients were enrolled in the final analysis, with 322 patients in the training set and 142 patients in the validation set. The prevalence of LNM was 3.29% (5/152) for intramucosal cancer and increased to 26.40% (85/322) for submucosal cancer. Multivariate logistic analysis showed that tumor size, invasive depth, tumor differentiation, infiltrative growth pattern, tumor budding, and lymphovascular invasion were significantly correlated with LNM. A nomogram using these six variables showed good discrimination with an area under the ROC curve of 0.789 (95%CI: 0.737-0.841) in the training set and 0.827 (95%CI: 0.755-0.899) in the validation set.

CONCLUSION

We developed a useful nomogram model to predict LNM risk for superficial ESCC patients which will facilitate additional decision-making in treating patients who undergo endoscopic resection.

Keywords: Superficial esophageal squamous cell carcinoma, Lymph node metastasis, Risk factors, Nomogram, Predictive model

Core Tip: This is a retrospective study to identify risk factors for lymph node metastasis (LNM) in superficial esophageal squamous cell carcinoma (ESCC) and to develop a nomogram model for predicting LNM. A total of 474 superficial ESCC patients who underwent esophagectomy were enrolled. Multivariate logistic analysis showed that tumor size, invasive depth, tumor differentiation, infiltrative growth pattern, tumor budding, and lymphovascular invasion were significantly correlated with LNM. A predictive nomogram using these six variables showed good performance and will facilitate the treatment choice for superficial ESCC patients.