国际医学放射学杂志2026，Vol.49Issue(1)：13-21,9.DOI:10.19300/j.2026.L22593
CT影像列线图模型术前预测食管鳞癌新辅助免疫化疗后增大的区域淋巴结转移的价值
A CT-based nomogram for preoperative prediction of metastatic enlarged regional lymph nodes after neoadjuvant immunochemotherapy in esophageal squamous cell carcinoma
摘要
Abstract
Objective To develop a nomogram based on subjective features from contrast-enhanced CT and to evaluate its ability to predict the metastatic risk of enlarged regional lymph nodes after neoadjuvant immunochemotherapy(nICT)in patients with esophageal squamous cell carcinoma(ESCC).Methods This retrospective multicenter study enrolled 60 patients with locally advanced ESCC who underwent nICT followed by surgical resection at three medical centers.A total of 81 radiologically enlarged regional lymph nodes identified on post-nICT CT scans with matched pathological results were analyzed.Long-axis diameter(LAD),short-axis diameter(SAD),and multiple radiologic features of lymph nodes were evaluated.Univariate and multivariate logistic regression analyses were performed to identify independent predictors of nodal metastasis and to construct a nomogram.Model performance was assessed using receiver operating characteristic(ROC)curves and the area under the curve(AUC),with DeLong's test used for comparisons.Internal validation was conducted using bootstrap resampling.Model discrimination,calibration,and clinical utility were evaluated using the concordance index(C-index),calibration curves,and decision curve analysis(DCA),respectively.Results Multivariate analysis identified a smaller percentage change in LAD(ΔLAD),the presence of radiologic extranodal extension(iENE),and loss of kidney-shaped morphology as independent predictors of lymph node metastasis.The nomogram demonstrated excellent predictive performance,with a C-index of 0.903 and a bootstrap-corrected C-index of 0.893.The AUC of the nomogram was 0.903,with a sensitivity of 90.0%and specificity of 78.7%,significantly outperforming any single imaging feature alone(all P<0.05).Calibration curves showed good agreement between predicted probabilities and observed outcomes.DCA indicated that the combined model provided a higher net benefit across a wide range of threshold probabilities(0.10-0.75).In addition,a ΔLAD cutoff value greater than 27%effectively differentiated reactive nodal enlargement from metastatic nodes,with a sensitivity of 75.0%and specificity of 63.9%.Conclusion The CT-based nomogram developed in this study enables reliable preoperative prediction of metastatic status in enlarged regional lymph nodes after nICT in ESCC patients.This model may serve as a practical imaging tool to distinguish immune-related pseudoprogression from true nodal metastasis and to facilitate individualized treatment planning.关键词
食管癌/淋巴结转移/新辅助免疫化疗/列线图Key words
Esophageal neoplasms/Lymphatic metastasis/Neoadjuvant immunochemotherapy/Nomogram分类
医药卫生引用本文复制引用
陈嘉慧,高莹莹,宁梓妤,李欣明,韩路军,谢辰仪,胡艺怀,刘再毅..CT影像列线图模型术前预测食管鳞癌新辅助免疫化疗后增大的区域淋巴结转移的价值[J].国际医学放射学杂志,2026,49(1):13-21,9.基金项目
国家青年科学基金(82302299,82202840) （82302299,82202840）
中国博士后科学基金(2022M720853,2023T160134) （2022M720853,2023T160134）
