Development and internal validation of a nomogram incorporating C-reactive protein-to-albumin ratio for predicting esophageal stricture after endoscopic submucosal dissection in early esophageal neoplasia.
- 1Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
- 2Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
- 3Department of Ningbo Institute of Innovation for Combined Medicine and Engineering, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
Abstract
Endoscopic submucosal dissection (ESD) for early esophageal neoplasia may cause strictures that impair eating and quality of life. Existing models rely on anatomical factors; the value of inflammatory-nutritional markers like the C-reactive protein-to-albumin ratio (CAR) remains unclear. We aimed to develop and internally validate a CAR-based nomogram for post-ESD stricture. This retrospective single-center study (2015-2024) included consecutive ESD patients with early esophageal neoplasia, excluding those with additional therapy, multiple lesions, comorbidities, recent infections, steroids, or loss to follow-up. Stricture: dysphagia or inability to pass a 9.8-mm scope within 12 months. CAR = preoperative C-reactive protein / albumin. The model was developed on the full cohort and internally validated via 1,000 bootstrap resamples (optimism-corrected). Logistic regression built the nomogram. Performance: area under the curve (AUC), sensitivity/specificity, calibration (Brier), and decision curve analysis (DCA). Of 111 patients, 36 (32.4%) developed stricture. Independent predictors were infiltration depth (< M2 vs. ≥ M2), longitudinal length (<3.75 vs. ≥3.75 cm), circumferential extent (<0.5, 0.5-0.75, ≥0.75), and CAR (<0.03 vs. ≥0.03). The nomogram achieved an AUC of 0.866 [95% confidence interval (CI): 0.800-0.931]. At the optimal cutoff, the sensitivity was 73.2% (95% CI: 56.9-85.4), specificity 83.1% (95% CI: 72.5-90.4), Brier score 0.122, and optimism-corrected AUC 0.889. Calibration and decision curves showed good performance and net benefit. CAR independently predicts post-ESD stricture. The nomogram is a promising preliminary risk-stratification tool, but requires external validation before its routine clinical use.
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BibTeX
@article{tang2026development,
title = {{Development and internal validation of a nomogram incorporating C-reactive protein-to-albumin ratio for predicting esophageal stricture after endoscopic submucosal dissection in early esophageal neoplasia.}},
author = {Mengqiu Tang and Chen Wang and Yang Zhou and Tian Chen},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-1725},
url = {https://europepmc.org/article/MED/42996922},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Development and internal validation of a nomogram incorporating C-reactive protein-to-albumin ratio for predicting esophageal stricture after endoscopic submucosal dissection in early esophageal neoplasia.
AU - Mengqiu Tang
AU - Chen Wang
AU - Yang Zhou
AU - Tian Chen
PY - 2026
DA - 2026/09/28
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1725
UR - https://europepmc.org/article/MED/42996922
AB - Endoscopic submucosal dissection (ESD) for early esophageal neoplasia may cause strictures that impair eating and quality of life. Existing models rely on anatomical factors; the value of inflammatory-nutritional markers like the C-reactive protein-to-albumin ratio (CAR) remains unclear. We aimed to develop and internally validate a CAR-based nomogram for post-ESD stricture. This retrospective single-center study (2015-2024) included consecutive ESD patients with early esophageal neoplasia, excluding those with additional therapy, multiple lesions, comorbidities, recent infections, steroids, or loss to follow-up. Stricture: dysphagia or inability to pass a 9.8-mm scope within 12 months. CAR = preoperative C-reactive protein / albumin. The model was developed on the full cohort and internally validated via 1,000 bootstrap resamples (optimism-corrected). Logistic regression built the nomogram. Performance: area under the curve (AUC), sensitivity/specificity, calibration (Brier), and decision curve analysis (DCA). Of 111 patients, 36 (32.4%) developed stricture. Independent predictors were infiltration depth (< M2 vs. ≥ M2), longitudinal length (<3.75 vs. ≥3.75 cm), circumferential extent (<0.5, 0.5-0.75, ≥0.75), and CAR (<0.03 vs. ≥0.03). The nomogram achieved an AUC of 0.866 [95% confidence interval (CI): 0.800-0.931]. At the optimal cutoff, the sensitivity was 73.2% (95% CI: 56.9-85.4), specificity 83.1% (95% CI: 72.5-90.4), Brier score 0.122, and optimism-corrected AUC 0.889. Calibration and decision curves showed good performance and net benefit. CAR independently predicts post-ESD stricture. The nomogram is a promising preliminary risk-stratification tool, but requires external validation before its routine clinical use.
SN - 2072-1439
SN - 2077-6624
ER -