Clinical nomogram for lymph node metastasis in pathological T1 esophageal squamous cell carcinoma: a multicenter retrospective study

Dong Tian; Kai-Yuan Jiang; Heng Huang; Shun-Hai Jian; Yin-Bin Zheng; Xiao-Guang Guo; Hong-Yun Li; Jing-Qiu Zhang; Ke-Xuan Guo; Hong-Ying Wen

doi:10.21037/atm.2020.02.185

Clinical nomogram for lymph node metastasis in pathological T1 esophageal squamous cell carcinoma: a multicenter retrospective study

Ann Transl Med. 2020 Mar;8(6):292. doi: 10.21037/atm.2020.02.185.

Authors

Dong Tian^{1

2}, Kai-Yuan Jiang³, Heng Huang³, Shun-Hai Jian⁴, Yin-Bin Zheng⁵, Xiao-Guang Guo⁶, Hong-Yun Li¹, Jing-Qiu Zhang¹, Ke-Xuan Guo¹, Hong-Ying Wen¹

Affiliations

¹ Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
² Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
³ College of Clinical Medicine, North Sichuan Medical College, Nanchong 637000, China.
⁴ Department of Pathology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
⁵ Department of Thoracic Surgery, Nanchong Central Hospital, Nanchong 637000, China.
⁶ Department of Pathology, Nanchong Central Hospital, Nanchong 637000, China.

Abstract

Background: Endoscopic resection is increasingly used to treat pathological T1 (pT1) esophageal cancer (EC) patients. However, the procedures are limited by lymph node metastasis (LNM) and remain controversial. We aimed to construct a nomogram to predict the risk of LNM in patients with pT1 esophageal squamous cell carcinoma (ESCC).

Methods: A total of 243 patients with pT1 ESCC who underwent esophagectomy and lymph node dissection at two different institutes between February 2013 and June 2019 were analyzed retrospectively. Patients were categorized into the negative group and the positive group according to whether there was LNM. Risk factors for LNM were evaluated by univariate and multivariate analyses. The nomogram was used to estimate the individual risk of LNM.

Results: Forty-six (18.9%) of the 243 patients with pT1 ESCC exhibited LNM. The LNM rate in patients with stage T1a disease was 5.7% (5/88), and the rate in patients with stage T1b disease was 26.5% (41/155). Multivariable logistic regression analysis showed that tumor differentiation [odds ratio (OR) =1.942, 95% confidence interval (CI): 1.067-3.536, P=0.030], the T1 sub-stage (OR =4.750, 95% CI: 1.658-13.611, P=0.004), the preoperative alanine aminotransferase/aspartate aminotransferase ratio (LSR) (OR =5.371, 95% CI: 1.676-17.210, P=0.005), and the high-density lipoprotein cholesterol (HDL-C) level (OR =5.894, 95% CI: 1.917-18.124, P=0.002) were independent risk factors for LNM. The nomogram had relatively high accuracy, with an area under the receiver operating characteristic curve (AUC) of 0.803 (95% CI: 0.732-0.873). The calibration curve showed that the predicted probability of LNM was in good agreement with the actual probability.

Conclusions: Clinicopathological and hematological parameters of tumor differentiation, the T1 sub-stage, the preoperative LSR, and the HDL-C level may predict the risk of LNM in T1 ESCC. The risk of LNM can be predicted by the nomogram.

Keywords: Lymph node metastasis (LNM); T1; esophageal squamous cell carcinoma (ESCC); nomogram; risk factors.