Prognostic model for early gastric cardia cancer after endoscopic submucosal dissection

To develop and validate a prognostic model incorporating microRNA-1246 (miR-1246), high-mobility group box 1 (HMGB-1), α1-antitrypsin (A1AT), and inflammatory markers for predicting outcomes in early gastric cardia cancer after endoscopic submucosal dissection (ESD).

We retrospectively enrolled 280 patients with early gastric cardia cancer who underwent ESD between January 2021 and December 2023. Patients were divided into a training set (n = 196) and a validation set (n = 84) at a ratio of 7:3. Influencing factors were screened using univariate, Least Absolute Shrinkage and Selection Operator (LASSO), and multivariate logistic regression analyses in the training set. A nomogram was constructed, and the predictive performance was assessed using receiver operating characteristic (ROC) curves and calibration curves. Decision curve analysis (DCA) was used to evaluate the clinical value.

The incidence of poor prognosis was comparable between training (43.88%) and validation set (34.52%). Multivariate logistic regression analysis identified miR-1246, HMGB-1, A1AT, tumor necrosis factor-α (TNF-α), and Helicobacter pylori infection as independent risk factors for poor prognosis (All P < 0.05). The nomogram demonstrated acceptable discriminative ability, with AUC of 0.789 (95% CI: 0.701-0.877) in the training set and 0.735 (95% CI: 0.638-0.835) in the validation set. The sensitivity and specificity were 0.625 and 0.841 for the training set, and 0.481 and 0.786 for the validation set, respectively. Calibration curves indicated good agreement between predicted and observed probabilities.

The proposed prognostic model offers a practical tool for individualized risk assessment post-ESD. However, the clinical application warrants further validation in large-scale, multi-center prospective studies with long-term follow-up.