Supraclavicular Lymph Node Metastasis In Elderly Patients Undergoing ESCC Radical Surgery: Construction Of Risk And Prognostic Predictive Nomograms

Background: Metastasis of supraclavicular lymph nodes severely affects the prognosis of esophageal cancer.However,elderly patients undergoing cervical supraclavicular lymph node dissection have great trauma and many postoperative complications.How to perform targeted dissection for patients with high-risk supraclavicular lymph node metastasis and avoid more trauma caused by unnecessary enlargement surgery has become an urgent problem to be solved.We plan to establish a nomographical predi-ction model to analyze the known clinical data to quantitatively evaluate the risk of postoperative supraclavicular lymph node metastasis and guide prognosis and decision-making.Methods: This article retrospectively analyzed 90 elderly patients with esophageal squamous cell carcinoma(ESCC)from January 2008 to December 2013 in our hospital.The independent risk factors influencing the metastasis of supraclavicular lymph nodes after radical resection of ESCC were determined by logistic univariate and multivariate analysis.The ROC curve and AUC(C-index)under the ROC curve were drawn to judge t the predictive value and prediction accuracy of the independent risk factors,and calculate the Hosmer-Lemeshow fit(H)Evaluate the goodness of fit of independent risk factors and draw a nomogram to quantify the risk of supraclavicular lymph node metastasis for individualized evaluation.The independent risk factors of supraclavicular lymph node metastasis after radical resection of esophageal squamous cell carcinoma(ESCC)in elderly patients were determined Through COX univariate and multivariate analysis.The Kaplan-Meier survival curve and cumulative risk curve were further drawn,and the effects of metastasis of supraclavicular lymph nodes on the survival prognosis of elderly patients with esophageal squamous cell carcinoma(ESCC)after radical resection were compared by log rank test.Finally,the net benefit of the model is evaluated by drawing a decision curve,which is used to guide clinical decision-making.Results:Among the 90 patients,31 were female(34.44%)and 59 were male(65.56%).The average age was 70.44 years old(65-85 years old),and the logistic regression model suggested that postoperative lymph node metastasis(P<0.05),vascular tumor thromboembolism(P<0.05)and invasion tissues(P<0.05)were independent risk factors for supraclavicular lymph node metastasis after ESCC radical surgery in elderly patients.The area under the ROC curve indicated that the three risk factors had good predictive value and accuracy(postoperative lymph node metastasis 0.727,invasion tissue 0.715,vascular thromboembolism 0.727).Hosmer--Lemeshow fitting degree(H)=0.687>0.05,the model fitted well.Among them,10 elderly patients(11.11%)had positive postoperative lymph node metastasis,vascular tumor embolism and invasion tissue,and the supr aclavicular lymph node metastasis rate was 100%(10/10),while 41 elderly patients(45.56%)had negative postoperative lymph node metastasis,vascular tumor embolism and invasion tissue,and the supraclavicular lymph node metastasis rate was 9.76%(4/41).COX univariate and multivariate analysis showed that postoperative lymph node metastasis(P<0.05),vascular tumor embolism(P<0.05)and invasion tissue(P<0.05)were still independent risk factors for supraclavicular lymph node metastasis in elderly ESCC radical surgery.Kaplan-meier survival curve and cumulative risk curve analysis showed:The influence of supraclavicular lymph node metastasis on postoperative survival in elderly ESCC patients was statistically significant(P=0.028,P <0.05);with the passage of time,the cumulative risk of supraclavicular lymph node metastasis increased,the survival probability decreased,and the survival time shortened.The decision curve suggests that in the range of metastasis risk of 0.14-0.63,using multiple independent risk factors to assess and predict the survival probability of elderly patients with ESCC has more clinical practical value.Conclusion: Postoperative lymph node metastasis,vascular tumor thrombus,and tumor infiltration are independent risk factors for supraclavicular lymph node metastasis after radical resection of esophageal squamous cell carcinoma(ESCC)in elderly patients.The nomogram model built on this basis can be used for patient risk assessment and survival analysis.It also provides a quantifiable risk basis for the elderly patients with esophageal squamous cell carcinoma(ESCC)who undergo radical radical dissection of the thoracoabdominal lymph nodes.