Development and validation of a nomogram model for the prediction of 4L lymph node metastasis in thoracic esophageal squamous cell carcinoma
ObjectivesThe left tracheobronchial (4L) lymph nodes (LNs) are considered as regional LNs for esophageal squamous cell carcinoma (ESCC), but there is a controversy about routine prophylactic 4L LN dissection for all resectable ESCCs. This study aimed to develop a nomogram for preoperative prediction...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-10-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.887047/full |
| _version_ | 1818024354469904384 |
|---|---|
| author | Lei Xu Jia Guo Shu Qi Hou-nai Xie Xiu-feng Wei Yong-kui Yu Ping Cao Rui-xiang Zhang Xian-kai Chen Yin Li |
| author_facet | Lei Xu Jia Guo Shu Qi Hou-nai Xie Xiu-feng Wei Yong-kui Yu Ping Cao Rui-xiang Zhang Xian-kai Chen Yin Li |
| author_sort | Lei Xu |
| collection | DOAJ |
| description | ObjectivesThe left tracheobronchial (4L) lymph nodes (LNs) are considered as regional LNs for esophageal squamous cell carcinoma (ESCC), but there is a controversy about routine prophylactic 4L LN dissection for all resectable ESCCs. This study aimed to develop a nomogram for preoperative prediction of station 4L lymph node metastases (LNMs).MethodsA total of 522 EC patients in the training cohort and 370 in the external validation cohort were included. The prognostic impact of station 4L LNM was evaluated, and multivariable logistic regression analyses were performed to identify independent risk factors of station 4L LNM. A nomogram model was developed based on multivariable logistic regression analysis. Model performance was evaluated in both cohorts in terms of calibration, discrimination, and clinical usefulness.ResultsThe incidence of station 4L LNM was 7.9% (41/522) in the training cohort. Patients with station 4L LNM exhibited a poorer 5-year overall survival rate than those without (43.2% vs. 71.6%, p < 0.001). In multivariate logistic regression analyses, six variables were confirmed as independent 4L LNM risk factors: sex (p = 0.039), depth of invasion (p = 0.002), tumor differentiation (p = 0.016), short axis of the largest 4L LNs (p = 0.001), 4L conglomeration (p = 0.006), and 4L necrosis (p = 0.002). A nomogram model, containing six independent risk factors, demonstrated a good performance, with the area under the curve (AUC) of 0.921 (95% CI: 0.878–0.964) in the training cohort and 0.892 (95% CI: 0.830–0.954) in the validation cohort. The calibration curve showed a good agreement on the presence of station 4L LNM between the risk estimation according to the model and histopathologic results on surgical specimens. The Hosmer–Lemeshow test demonstrated a non-significant statistic (p = 0.691 and 0.897) in the training and validation cohorts, which indicated no departure from the perfect fit. Decision curve analysis indicated that the model had better diagnostic power for 4L LNM than the traditional LN size criteria.ConclusionsThis model integrated the available clinical and radiological risk factors, facilitating in the precise prediction of 4L LNM in patients with ESCC and aiding in personalized therapeutic decision-making regarding the need for routine prophylactic 4L lymphadenectomy. |
| first_indexed | 2024-12-10T03:58:53Z |
| format | Article |
| id | doaj.art-5c9afa0affbc4fb2a19061e5fa5b0af4 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-10T03:58:53Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-5c9afa0affbc4fb2a19061e5fa5b0af42022-12-22T02:03:02ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-10-011210.3389/fonc.2022.887047887047Development and validation of a nomogram model for the prediction of 4L lymph node metastasis in thoracic esophageal squamous cell carcinomaLei Xu0Jia Guo1Shu Qi2Hou-nai Xie3Xiu-feng Wei4Yong-kui Yu5Ping Cao6Rui-xiang Zhang7Xian-kai Chen8Yin Li9Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, ChinaDepartment of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, ChinaDepartment of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaObjectivesThe left tracheobronchial (4L) lymph nodes (LNs) are considered as regional LNs for esophageal squamous cell carcinoma (ESCC), but there is a controversy about routine prophylactic 4L LN dissection for all resectable ESCCs. This study aimed to develop a nomogram for preoperative prediction of station 4L lymph node metastases (LNMs).MethodsA total of 522 EC patients in the training cohort and 370 in the external validation cohort were included. The prognostic impact of station 4L LNM was evaluated, and multivariable logistic regression analyses were performed to identify independent risk factors of station 4L LNM. A nomogram model was developed based on multivariable logistic regression analysis. Model performance was evaluated in both cohorts in terms of calibration, discrimination, and clinical usefulness.ResultsThe incidence of station 4L LNM was 7.9% (41/522) in the training cohort. Patients with station 4L LNM exhibited a poorer 5-year overall survival rate than those without (43.2% vs. 71.6%, p < 0.001). In multivariate logistic regression analyses, six variables were confirmed as independent 4L LNM risk factors: sex (p = 0.039), depth of invasion (p = 0.002), tumor differentiation (p = 0.016), short axis of the largest 4L LNs (p = 0.001), 4L conglomeration (p = 0.006), and 4L necrosis (p = 0.002). A nomogram model, containing six independent risk factors, demonstrated a good performance, with the area under the curve (AUC) of 0.921 (95% CI: 0.878–0.964) in the training cohort and 0.892 (95% CI: 0.830–0.954) in the validation cohort. The calibration curve showed a good agreement on the presence of station 4L LNM between the risk estimation according to the model and histopathologic results on surgical specimens. The Hosmer–Lemeshow test demonstrated a non-significant statistic (p = 0.691 and 0.897) in the training and validation cohorts, which indicated no departure from the perfect fit. Decision curve analysis indicated that the model had better diagnostic power for 4L LNM than the traditional LN size criteria.ConclusionsThis model integrated the available clinical and radiological risk factors, facilitating in the precise prediction of 4L LNM in patients with ESCC and aiding in personalized therapeutic decision-making regarding the need for routine prophylactic 4L lymphadenectomy.https://www.frontiersin.org/articles/10.3389/fonc.2022.887047/fullleft tracheobronchial (4L) lymph nodeslymphadenectomynomogramlymph node metastasesesophageal squamous cell carcinoma |
| spellingShingle | Lei Xu Jia Guo Shu Qi Hou-nai Xie Xiu-feng Wei Yong-kui Yu Ping Cao Rui-xiang Zhang Xian-kai Chen Yin Li Development and validation of a nomogram model for the prediction of 4L lymph node metastasis in thoracic esophageal squamous cell carcinoma Frontiers in Oncology left tracheobronchial (4L) lymph nodes lymphadenectomy nomogram lymph node metastases esophageal squamous cell carcinoma |
| title | Development and validation of a nomogram model for the prediction of 4L lymph node metastasis in thoracic esophageal squamous cell carcinoma |
| title_full | Development and validation of a nomogram model for the prediction of 4L lymph node metastasis in thoracic esophageal squamous cell carcinoma |
| title_fullStr | Development and validation of a nomogram model for the prediction of 4L lymph node metastasis in thoracic esophageal squamous cell carcinoma |
| title_full_unstemmed | Development and validation of a nomogram model for the prediction of 4L lymph node metastasis in thoracic esophageal squamous cell carcinoma |
| title_short | Development and validation of a nomogram model for the prediction of 4L lymph node metastasis in thoracic esophageal squamous cell carcinoma |
| title_sort | development and validation of a nomogram model for the prediction of 4l lymph node metastasis in thoracic esophageal squamous cell carcinoma |
| topic | left tracheobronchial (4L) lymph nodes lymphadenectomy nomogram lymph node metastases esophageal squamous cell carcinoma |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.887047/full |
| work_keys_str_mv | AT leixu developmentandvalidationofanomogrammodelforthepredictionof4llymphnodemetastasisinthoracicesophagealsquamouscellcarcinoma AT jiaguo developmentandvalidationofanomogrammodelforthepredictionof4llymphnodemetastasisinthoracicesophagealsquamouscellcarcinoma AT shuqi developmentandvalidationofanomogrammodelforthepredictionof4llymphnodemetastasisinthoracicesophagealsquamouscellcarcinoma AT hounaixie developmentandvalidationofanomogrammodelforthepredictionof4llymphnodemetastasisinthoracicesophagealsquamouscellcarcinoma AT xiufengwei developmentandvalidationofanomogrammodelforthepredictionof4llymphnodemetastasisinthoracicesophagealsquamouscellcarcinoma AT yongkuiyu developmentandvalidationofanomogrammodelforthepredictionof4llymphnodemetastasisinthoracicesophagealsquamouscellcarcinoma AT pingcao developmentandvalidationofanomogrammodelforthepredictionof4llymphnodemetastasisinthoracicesophagealsquamouscellcarcinoma AT ruixiangzhang developmentandvalidationofanomogrammodelforthepredictionof4llymphnodemetastasisinthoracicesophagealsquamouscellcarcinoma AT xiankaichen developmentandvalidationofanomogrammodelforthepredictionof4llymphnodemetastasisinthoracicesophagealsquamouscellcarcinoma AT yinli developmentandvalidationofanomogrammodelforthepredictionof4llymphnodemetastasisinthoracicesophagealsquamouscellcarcinoma |