Prediction of individuals at high absolute risk of esophageal squamous cell carcinoma

• Background and Aims: This study aimed to develop a prediction model for identifying individuals at high absolute risk of esophageal squamous cell carcinoma (ESCC) for endoscopic screening at a curable stage based on readily identifiable risk factors. Methods: This was a nationwide Swedish population-based case-control study, including 167 new cases of ESCC and 820 randomly selected control participants. Odds ratios with 95% confidence intervals (CI) were assessed using multivariable unconditional logistic regression. The discriminative accuracy of the model was assessed by the area under the receiver operating characteristic curve (AUC) with leave-one-out cross-validation. Models for projecting individuals’ absolute 5-year risk of ESCC were developed by incorporating the age- and sex-specific incidence rates and competing risk of death from other causes. Results: A model including the risk factors age, sex, tobacco smoking, alcohol overconsumption, education, duration of living with a partner, and place of residence during childhood generated an AUC of 0.81 (95% CI 0.77-0.84). A model based only on age, sex, tobacco smoking, and alcohol overconsumption obtained a similar AUC (0.79, 95% CI 0.75-0.82). A 5-year follow-up of 355 men aged 70-74 years with over 35 years’ smoking and alcohol overconsumption history is needed to detect one ESCC case. The estimated individuals’ absolute 5-year risk of ESCC varied according to combinations of risk factors. Conclusions: This “easy-to-use” risk prediction model showed a good discriminative accuracy and had the potential to identify individuals at high absolute risk of ESCC who might benefit from tailored endoscopic screening and surveillance.

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