Modeling the risk of esophageal squamous cell carcinoma and squamous dysplasia in a high risk area in Iran.

Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Iran.
Archives of Iranian medicine (Impact Factor: 1.11). 01/2012; 15(1):18-21.
Source: PubMed


Identifying people at higher risk of having squamous dysplasia, the precursor lesion for esophageal squamous cell carcinoma (ESCC), would allow targeted endoscopic screening.
We used multivariate logistic regression models to predict ESCC and dysplasia as outcomes. The ESCC model was based on data from the Golestan Case-Control Study (total n = 871; cases = 300), and the dysplasia model was based on data from a cohort of subjects from a gastroenterology clinic in Northeast Iran (total n = 724; cases = 26). In each of these analyses, we fit a model including all risk factors known in this region to be associated with ESCC. Individual risks were calculated using the linear combination of estimated regression coefficients and individual-specific values for covariates. We used cross-validation to determine the area under the curve (AUC) and to find the optimal cut points for each of the models.
The model had an area under the curve of 0.77 (95% CI: 0.74-0.80) to predict ESCC with 74% sensitivity and 70.4% specificity for the optimum cut point. The area under the curve was 0.71 (95% CI: 0.64-0.79) for dysplasia diagnosis, and the classification table optimized at 61.5% sensitivity and 69.5% specificity. In this population, the positive and negative predictive values for diagnosis of dysplasia were 6.8% and 97.8%, respectively.
Our models were able to discriminate between ESCC cases and controls in about 77%, and between individuals with and without squamous dysplasia in about 70% of the cases. Using risk factors to predict individual risk of ESCC or squamous dysplasia still has limited application in clinical practice, but such models may be suitable for selecting high risk individuals in research studies, or increasing the pretest probability for other screening strategies.

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Available from: Reza Malekzadeh, Oct 03, 2015
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    • "Thus , additional capsule sponge studies are needed , which include larger numbers of subjects with high - grade ESD , to evaluate the reproducibility and stability of our current findings . This may be achieved by selecting especially high - risk individuals for screening , using previously identified risk factors ( Roshandel et al , 2014 ) and risk stratification models ( Etemadi et al , 2012 ) . "
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    ABSTRACT: Background: Oesophageal squamous cell carcinoma (ESCC) is a fatal disease with 5-year survival rates of <5% in Northern Iran. Oesophageal squamous dysplasia (ESD) is the precursor histologic lesion of ESCC. This pilot study was conducted to assess the feasibility, safety, and acceptability of non-endoscopic cytological examination of the oesophagus and to provide initial data on the accuracy of cytological atypia for identifying patients with ESD in this very-high-risk area. Methods: Randomly selected asymptomatic participants of the Golestan Cohort Study were recruited. A cytological specimen was taken using a capsule sponge device and evaluated for atypical cells. Sections of the cytological specimen were also stained for p53 protein. Patient acceptability was assessed using a visual analogue scale. The cytological diagnosis was compared with a chromoendoscopic examination using Lugol's solution. Results: Three hundred and forty-four subjects (43% male, mean (s.d.) age 55.6 (7.9) years) were referred to the study clinic. Three hundred and twelve met eligibility criteria and consented, of which 301 subjects (96.5%) completed both cytological and endoscopic examinations. There were no complications. Most of the participants (279; 92.7%) were satisfied with the examination. The sensitivity and specificity of the cytological examination for identifying subjects with high-grade ESD were 100 and 97%, respectively. We found an accuracy of 100% (95% CI=99-100%) for a combination of cytological examination and p53 staining to detect high-grade ESD. Conclusions: The capsule sponge methodology seems to be a feasible, safe, and acceptable method for diagnosing precancerous lesions of the oesophagus in this population, with promising initial accuracy data for the detection of high-grade ESD.
    British Journal of Cancer 09/2014; 111(12). DOI:10.1038/bjc.2014.506 · 4.84 Impact Factor
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    • "In a previous study by Etemadi et al., 2012, statistical models have been used for modeling and prediction of squamous dysplasia , and ESCC using their risk factors. But in fact, for most practical applications relating complex natural and biological phenomena, like occurrence of squamous dysplasia, and ESCC, statistics is imprecise and cannot be helpful for several reasons. "
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    Journal of Theoretical Biology 06/2013; 334. DOI:10.1016/j.jtbi.2013.05.031 · 2.12 Impact Factor
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    • "In a previous study by Etemadi et al. in 2012 [7], a logistic regression model has been exploited for modeling and prediction of squamous dysplasia, and ESCC using their risk factors. The classification methods that try to calculate the probability distributions, like the method used by Etemadi et al. to Contents lists available at ScienceDirect journal homepage: "
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    ABSTRACT: Early detection of squamous dysplasia and esophageal squamous cell carcinoma is of great importance. Adopting computer aided algorithms in predicting cancer risk using its risk factors can serve in limiting the clinical screenings to people with higher risks. In the present study, we show that the application of an advanced classification method, the Minimum Classification Error, could considerably enhance the classification performance in comparison to the logistic regression model and the variable structure fuzzy neural network, as the latest successful methods. The results yield the accuracy of 89.65% for esophageal squamous cell carcinoma, and 88.42% for squamous dysplasia risk prediction.
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