| Objective To analyze the risk factors of esophageal stricture after endoscopic submucosal dissection(ESD) for early esophageal cancer and establish a corresponding prediction model. Methods A retrospective analysis was performed on the pathological and clinical data of 52 patients with early esophageal cancer who met the criteria admitted by the Department of Gastroenterology of Lu'an People's Hospital's from June 2018 to December 2021, and the patients were divided into stenosis group(n=15 cases) and non-stenosis group(n=37cases) according to whether esophageal stenosis occurred after surgery. The indicators related to postoperative esophageal stenosis were obtained by comparing the baseline data analysis of the two groups, and then the relevant indicators were included in the multivariate Logistic regression analysis to obtain independent factors affecting the occurrence of esophageal stricture after surgery, and a Logistic linear regression model was constructed based on the corresponding coefficients of the above factors, the predicted value of the model was evaluated by the receiver working characteristic(ROC) curve, and the goodness-of-fit test was selected to evaluate the consistency between the predicted value and the actual value. Results The results of univariate analysis showed that the injury of the muscularis propria, the circumferential extent of the lesion, the depth of tumor invasion, and the length of the longitudinal diameter of the dissection were the influencing factors of esophageal stenosis after ESD(all P<0.05). The results of multivariate Logistic regression analysis indicated that there was muscularis propria injury(OR=4.310, 95%CI:2.307~8.055), the circumference of the lesion was >3/4 circumference(OR=12.820, 95%CI=3.781~43.470), the progression of tumor invasion depth to M3-SM1 stage(OR=6.482, 95%CI=2.747~15.294) and the longitudinal length of long dissection(OR=1.091, 95%CI=1.037~1.148) all affected the occurrence of stenosis after ESD independent risk factors(P<0.05). The prediction model was constructed according to the correlation coefficient between the constant obtained from the multivariate analysis and each risk factor:Logit(P)=1.461×muscularis propria injury(0 meaning no muscularis propria damage, 1 meaning muscularis propria damage) + 2.551×the circumference of the lesion(0meaning the circumference of the lesion was less than or equal to 3/4 circumference, 1 meaning the circumference of the lesion was >3/4 circumference) + 1.869×the depth of tumor invasion(0 means the depth of tumor invasion was M1-M2 stage), and 1 indicateing that the depth of tumor invasion was M3 to SM1 stage) + 0.087×the length of the longitudinal diameter of the peeling(measured value)-2.637. The area under the ROC curve of the model was 0.869(95%CI=0.743~0.996, P<0.001), indicating that the model had good discrimination; the maximum Youden index was 0.759, the corresponding sensitivity was 0.867, and the specificity was 0.892. Hosmer-Lemeshow goodness-of-fit test was used to evaluate the calibration degree of the model, and the result was χ2=4.864, P=0.772, indicating that there was no statistical difference between the predicted value of the model and the actual observed value, and the calibration ability was good. Conclusions Muscular propria injury, lesion circumferential range> 3/4 circumference, tumor invasion depth progression to M3~SM1 stage, longitudinal length of long dissection, and prediction model can effectively predict whether stenosis occurs after ESD in esophageal cancer patients, which has clinical reference value. |
