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. 2021 Jan 8:10:598603.
doi: 10.3389/fonc.2020.598603. eCollection 2020.

Estimating Individualized Absolute Risk for Esophageal Squamous Cell Carcinoma: A Population-Based Study in High-Risk Areas of China

Yi Shen  1 , Shuanghua Xie  2 , Lei Zhao  3 , Guohui Song  4 , Yi Shao  1 , Changqing Hao  5 , Chen Niu  1 , Xiaoli Ruan  1 , Zhaoping Zang  1 , Rena Nakyeyune  1 , Fen Liu  1 , Wenqiang Wei  2
Affiliations

Estimating Individualized Absolute Risk for Esophageal Squamous Cell Carcinoma: A Population-Based Study in High-Risk Areas of China

Yi Shen et al. Front Oncol. .

Abstract

Background: Esophageal squamous cell carcinoma (ESCC) has a high incidence rate and poor prognosis. In this study, we aimed to develop a predictive model to estimate the individualized 5-year absolute risk for ESCC in Chinese populations living in the high-risk areas of China.

Methods: We developed a risk-predicting model based on the epidemiologic data from a population-based case-control study including 244 newly diagnosed ESCC patients and 1,220 healthy controls. Initially, we included easy-to-obtain risk factors to construct the model using the multivariable logistic regression analysis. The area under the ROC curves (AUC) with cross-validation methods was used to evaluate the performance of the model. Combined with local age- and sex-specific ESCC incidence and mortality rates, the model was then used to estimate the absolute risk of developing ESCC within 5 years.

Results: A relative risk model was established that included eight factors: age, sex, tobacco smoking, alcohol drinking, education, and dietary habits (intake of hot food, intake of pickled/salted food, and intake of fresh fruit). The relative risk model had good discrimination [AUC, 0.785; 95% confidence interval (CI), 0.749-0.821]. The estimated 5-year absolute risk of ESCC for individuals varied widely, from 0.0003% to 19.72% in the studied population, depending on the exposure to risk factors.

Conclusions: Our model based on readily identifiable risk factors showed good discriminative accuracy and strong robustness. And it could be applied to identify individuals with a higher risk of developing ESCC in the Chinese population, who might benefit from further targeted screening to prevent esophageal cancer.

Keywords: absolute risk; esophageal squamous cell carcinoma; high-risk area; individualized; prediction model.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The ROC curves for the relative risk model in discriminating ESCC patients from healthy controls. (A) ROC curve without cross-validation (B) ROC curve with 10-fold cross-validation (C) ROC curve with leave-one-out cross-validation, The optimal cut-off points (dots) were marked on the ROC curves. ESCC, esophageal squamous cell carcinoma. ROC, receiver-operating characteristic curve.
Figure 2
Figure 2
Individualized absolute 5-year risk (%) of ESCC for (A) man and (B) woman, estimated from the relative risk model and local incidence and mortality rates. ESCC, esophageal squamous cell carcinoma.
Figure 3
Figure 3
The scatter plot of absolute 5-year risk (%) of ESCC in the studied Chinese population. ESCC, esophageal squamous cell carcinoma.
See this image and copyright information in PMC

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