基于CT图像的评分模型预测食管鳞癌喉返神经旁淋巴结转移风险

目的:基于原发肿瘤及淋巴结CT特征建立评分模型预测食管鳞癌患者喉返神经旁淋巴结（RLN-LN）转移风险。方法:回顾性收集2014年1月至2019年12月于北京大学肿瘤医院行食管癌根治术并清扫RLN-LN的92例食管鳞癌患者。根据术后淋巴结病理结果分为RLN-LN转移组（ n=37）和非转移组（ ...

Developing a CT scoring system to predict the metastasis of recurrent laryngeal nerve lymph nodes in esophageal squamous cell cancer

Objective To develop a scoring model based on CT feature of primary tumor and lymph node to predict the risk of recurrent laryngeal nerve lymph node(RLN-LN)metastasis in patients with esophageal squamous cell cancer(ESC).Methods A total of 92 ESC patients who received radical resection of esophageal carcinoma and RLN-LN dissections during January 2014 to November 2019 in Peking University Cancer Hospital were retrospectively reviewed,and were divided into metastatic group(n=37)and non-metastatic group(n=55)according to the postoperative pathological results of RLN-LN.Pre-operative thoracic CT imaging features were analyzed,including age,sex,differentiation,tumor locations,tumor sizes(length,thickness,the ratio of thickness to length),and RLN-LN sizes[short diameter,long diameter,the ratio of short diameter to longest diameter in multi-planner reformation(MPR)].The stepwise regression of multivariate logistic regression analysis was used to identify the useful features and establish scoring model.The diagnostic efficacy for RLN-LN metastisis of CT features and scoring model were evaluated using ROC curves.The differences of area under the curve(AUC)were compared using the Z test.The Hosmer-Lemeshow test and calibrating curve were used to evaluate model fitting.Results The tumor location,tumor length,short diameter of RLN-LN and short diameter/MPR long diameter were independent predictors of RLN-LN metastasis,and the AUC of diagnosis of RLN-LN metastasis was 0.586,0.705,0.831 and 0.777,respectively.A scoring model was established based on the above 4 CT features,and the AUC of the scoring model in diagnosing RLN-LN metastasis was 0.903(95%CI 0.846-0.959),which was better than each single CT feature(Z=5.812,P<0.001;Z=2.161,P=0.030;Z=2.929,P=0.003;Z=4.052,P<0.001).The Hosmer-Lemeshow test results showed P value of 0.555,and the calibration curve indicated that there was good consistency between the predicted risk of RLN-LN metastasis and the actual value.Conclusion The scoring model based on CT image can help to predict the risk stratification of RLN-LN metastasis in patients with ESC.