A nomogram for endoscopic screening in a high esophageal squamous cell cancer risk area: results from a population-based study

Jie Xing,1 Li Min,1 Hao Zhang,2 Peng Li,1 Wei Li,1 Fujin Lv,1 Yongjun Wang,1 Zheng Zhang,1 Hengcun Li,1 Qingdong Guo,1 Siyi Wang,1 Yu Zhao,1 Junmin Wang,3 Xiaoyan Shi,4 Anxin Wang,5 Shengtao Zhu,1 Ming Ji,1 Yongdong Wu,1 Shutian Zhang1 On behalf of the NCECS Study Group 1Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, People’s Republic of China; 2Department of Gastroenterology, Jizhong Energy Fengfeng Group Hospital, Handan, Hebei 056200, People’s Republic of China; 3Department of Gastroenterology, Handan Central Hospital, Handan, Hebei 056001, People’s Republic of China; 4Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People’s Republic of China; 5Department of Epidemiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100029, People’s Republic of China Background: Endoscopy is the main approach used for esophageal squamous cell carcinoma (ESCC) screening, especially in high-risk areas. However, little consensus has been achieved in recent ESCC screening programs, and endoscopists have selected patients only by age and family history. Patients and methods: To generate a proper strategy for selecting an eligible population for endoscopic screening based on demographic factors, lifestyle, and eating habits, a total of 7,830 residents in an area with a high risk of ESCC were recruited for this study. All participants underwent endoscopic examinations that were conducted by experienced endoscopists. Risk factors for ESCC and other lesions were selected by univariate and multivariate logistic regressions. A nomogram for the prediction of ESCC and premalignant lesions was constructed, which included information on age, sex, occupation, labor intensity, income, and mining exposure. Receiver operating characteristic (ROC) curve analysis was performed to present the predictive accuracy of the nomograms. Results: The area under the curve (95% CI) was 0.749 (0.711–0.788) for this nomogram. By applying this nomogram, we could exclude 60% (4704/7830) of patients before endoscopy screening and detect all ESCC cases as well as most esophageal lesions in the remaining population. Conclusion: In conclusion, we provided a ready-to-use preclinical tool with the potential to select eligible people with high risk of ESCC for endoscopy screening. Keywords: nomogram, endoscopy screening, ESCC, population-based study