Abstract
BACKGROUND OR PURPOSE: It is important to predict nodal metastases in patients with early esophageal cancer to stratify patients for endoscopic resection or esophagectomy. This study was to establish a novel artificial neural network (ANN) and assess its ability by comparing it with a traditional logistic regression (LR) model for predicting lymph node (LN) metastasis in patients with superficial esophageal squamous cell carcinoma (SESCC). METHODS: A primary cohort was established, composed of 733 patients who underwent esophagectomy for SESCC from December 2012 to December 2019. The following steps were applied: (i) predictor selection; (ii) development of an ANN and a LR model, respectively; (iii) cross-validation; and (iv) evaluation of performance between the two models. The diagnostic assessment was performed with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS: The established ANN model had 6 significant predictors: a past habit of alcohol taking, tumor size, submucosal invasion, histologic grade, lymph-vessel invasion, and preoperative CT result. The ANN model performed better than the LR model in specificity (91.20% vs 72.59%, p=0.006), PPV (56.49% vs 39.78%, p=0.020), accuracy (90.72% vs 74.49%, p<0.0001), C-index (91.5% vs 86.8%, p<0.001), and IDI (improved by 23.3%, p<0.001). There were no differences between these two models in sensitivity (87.06% vs 83.21%, p=0.764), NPV (98.17% vs 95.21%, p=0.627), and NRI (improved by -1.1%, p=0.824). CONCLUSION: This ANN model is superior to the LR model and may become a valuable tool for the prediction of LN metastasis in patients with SESCC.