Scoring system to identify patients at high risk of oesophageal cancer

Identification of a patient cohort at high risk of developing oesophageal cancer might enable a greater proportion of patients with curable disease stages to be identified and permit better use of investigative resources. The aim of this study was to develop a scoring system that identifies patients with dysphagia at greatest risk of having oesophageal cancer.

Data on 435 patients with dysphagia were recorded. Univariable and multivariable analyses were performed to identify parameters predictive of cancer. These were used to create the Edinburgh Dysphagia Score (EDS), which was then validated in a second cohort of patients.

The EDS contained six parameters: age, sex, weight loss, duration of symptoms, localization of dysphagia and acid reflux. It stratified the development cohort into a group at higher risk, containing 39 of 40 patients with cancer, and a group at lower risk, comprising 36·0 per cent of referrals (sensitivity 97·5 per cent, negative predictive value 99·3 per cent). On validation, the EDS divided the referrals into a higher-risk group identifying all 26 cancers and a lower-risk group comprising 30·0 per cent of referrals.

From 574 referrals, the EDS correctly classified as higher risk all but one patient with cancer. Some 34·0 per cent of patients identified as lower risk could have been investigated less urgently. This simple scoring system permits sensitive prioritization of patients referred with dysphagia, and enables more efficient use of investigative resources.