Abstract:

Objective

To establish a risk model of severe thrombocytopenia in patients with esophageal squamous cell carcinoma after concurrent radiotherapy and chemotherapy，and to explore its application value.

Methods

A total of 150 patients with esophageal squamous cell carcinoma admitted to Chang'an Hospital from January 2016 to January 2024 were selected，and divided into training set （n=105）and verification set （n=45） according to the ratio of 7∶3. According to the occurrence of severe thrombocytopenia during postoperative concurrent radiotherapy and chemotherapy，the patients in the training group were divided into the occurrence group and the non-occurrence group，and the clinical data of the two groups were compared. Logistic multivariate regression analysis was used to summarize the risk factors，and Nomogram was used to establish a prediction model，and receiver operating characteristic（ROC） curve was drawn to evaluate the effectiveness of the model. Validation set was used for model validation.

Results

Among the 105 patients in the training set，24 patients suffered from severe thrombocytopenia，with an incidence rate of 22.86%. Logistic regression analysis showed that age ≥65 years，diabetes mellitus and three cycles of induction chemotherapy were independent risk factors for severe thrombocytopenia in patients with esophageal squamous cell carcinoma during concurrent radiotherapy and chemotherapy （P＜0.05）. Taking the total score ≥83 as the cut-off value，the AUC predicted by Nomogram prediction model for patients with severe thrombocytopenia in the training set was 0.886，with sensitivity and specificity of 91.67% and 87.65%，positive predictive value and negative predictive value of 68.75% and 97.26% respectively. Among the 45 patients in the training set，10 patients suffered from severe thrombocytopenia，with an incidence rate of 22.22%. The AUC of patients with severe thrombocytopenia in the model prediction validation set was 0.822，and its sensitivity and specificity were 86.36% and 78.26%，respectively. The positive predictive value and negative predictive value were 79.17%and 85.17%，respectively.

Conclusion

The risk of severe thrombocytopenia in patients with esophageal squamous cell carcinoma after concurrent radiotherapy and chemotherapy is high，which is related to the patient's age，complications and induction chemotherapy cycle. The prediction model based on the above risk factors can provide reliable reference for the risk assessment of severe thrombocytopenia in patients.

Key words: Esophageal squamous cell carcinoma, Concurrent radiotherapy and chemotherapy, Severe thrombocytopenia, Risk model