Abstract
BACKGROUND: Esophageal cancer is a serious global health concern with poor prognosis in advanced stages. Immune checkpoint inhibitors (ICIs) have shown promise in enhancing survival, but they are associated with immune-related adverse events, including potentially life-threatening myocarditis. Moreover, ICI-induced myocarditis can be asymptomatic, necessitating early diagnosis. Specific risk factors and biomarkers for esophageal cancer remain poorly characterized. AIM: To investigate the determinants of ICI-associated asymptomatic myocarditis in patients with esophageal cancer and explore potential early biomarkers. METHODS: A retrospective analysis was conducted on 202 cancer patients who received treatment at Shanxi Province Cancer Hospital from July 2019 to July 2024. RESULTS: Older age, male gender, and elevated creatine kinase isoenzymes (CK-MB) and CK levels were found to be significant risk factors for asymptomatic myocarditis. The myocarditis occurrence group had higher CK-MB (3.05 ng/mL vs 5.02 ng/mL; P < 0.001) and CK levels (187.29 U/L vs 212.25 U/L; P = 0.005), and the predictive value of age, gender, CK, and CK-MB was low [are under the receiver operating characteristic curve (AUC) = 0.579-0.608]. However, their combination in a predictive model showed improved diagnostic capability, with an AUC of 0.808. CONCLUSION: Age, gender, and cardiac biomarker levels considerably contribute to the risk of ICI-related myocarditis in patients with esophageal cancer. The integration of these factors into a predictive model enhances early diagnosis, facilitating personalized risk management.