ArticleBMC gastroenterology2025
Risk factors and prediction model for submucosal invasion in early protruding-type esophagogastric junction adenocarcinoma: conventional endoscopy combines with endoscopic ultrasonography.
Article in BMC gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPrecise depth evaluation of protruding-type early esophagogastric junction adenocarcinoma (EGJAC) is critical for therapeutic planning. This study evaluated the diagnostic value of conventional endoscopy (CE) and endoscopic ultrasonography (EUS) for identifying suspected submucosal-invasive carcinomas and established a predictive model for SM2 invasion.
methodsA retrospective analysis included 111 patients with protruding-type EGJAC (2015-2024). CE macroscopic morphology, EUS diagnostic accuracy, and clinicopathological correlations were systematically assessed. multivariate analysis identified SM2 predictors. Construct a predictive nomogram for SM2-invading protruding-type early EGJAC incorporating CE macroscopic morphology, air-induced morphological changes, gastroesophageal reflux disease (GERD), EUS-verified, and submucosal cystic echoes. The predictive accuracy of the nomogram was evaluated through receiver operating characteristic (ROC) curve analysis and calibration validation.
resultsCE and EUS showed comparable overall diagnostic accuracy (65.7% vs. 69.3%). A numerical improvement in diagnostic yield was observed with EUS for CE-SM2 low-confidence lesions (41.7% vs. 24.0%). CE-SM2 low-confidence lesions demonstrated both significantly elevated GERD co-occurrence rates (56.0% vs. 13.8%; P = 0.038) and predominant abrupt elevation without depression morphology (AEw/oD: 64.0%), contrasting with abrupt elevation with depression morphology (AEwD: 71.4%) in high-confidence counterparts (P < 0.001). Multivariate analysis identified AEwD (OR = 8.57, 95% CI: 1.29-56.81) and absence of submucosal cystic echoes (OR = 6.97, 95% CI: 1.84-26.37) as independent SM2 predictors. The nomogram model for predicting SM2 invasion showed an area under the receiver operating characteristic (ROC) curve of 0.843 (95% CI: 0.732-0.954).
conclusionsA validated predictive model has been developed to identify SM2 invasion in protruding-type early EGJAC. This predictive tool additionally facilitates optimal treatment selection guidance for patients with protruding-type early EGJAC. In addition, accurate assessment of CE-SM2 low-confidence invasion in protruding-type early EGJAC requires integrated evaluation incorporating CE, EUS, and GERD parameters.
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