Scoring System for Esophageal Cancer Requires Other Considerations

Can a simple scoring system identify individuals at high risk of esophageal cancer?1

Background: The prevalence of esophageal cancer is rapidly expanding. The prognosis for late stage esophageal cancer is dismal, and survival depends on early diagnosis and treatment. Limitations in health care resources preclude screening all individuals with dysphagia.

Study design: Retrospective cohort study

Setting: University Hospital in Edinburgh, Scotland

Synopsis: Parameters independently associated with an elevated risk of esophageal cancer on multivariate analysis were age, male gender, dysphagia localized to chest and weight loss greater than 3 kg. The presence of symptoms of acid reflux and duration of symptoms longer than six months were associated with a lower risk of malignancy. Researchers developed a grading scale based on these risk factors, called the Edinburgh Dysphagia Score (EDS). An EDS > 3.4 displayed a sensitivity of 97.5 to 100 and a specificity of only 35.1 to 39.8. The scoring system did not evaluate the presence of extraesophageal reflux symptoms such as cough, globus, throat clearing and excessive throat mucus that have been identified as possible risk factors for esophageal cancer.2

Bottom line: In patients with dysphagia, male gender, advancing age, dysphagia localized to the chest, weight loss greater than 3 kg, the absence of reflux symptoms and symptoms shorter than six months duration are all independent risk factors for esophageal carcinoma. These factors should be considered when assessing the urgency of endoscopic evaluation of the esophagus. A scoring system based on these parameters displayed high sensitivity but poor specificity in predicting the presence of esophageal cancer. A limitation of the EDS is that it does not account for extraesophageal reflux symptoms that may be more predictive of the presence of esophageal cancer.

Citations

1. Rhatigan E, Tyrmpas I, Murray G, et al. Scoring system to identify patients at high risk of oesophageal cancer [published online ahead of print August 24, 2010]. Br J Surg.
2. Reavis KM, Morris CD, Gopal DV, et al. Laryngopharyngeal reflux symptoms better predict the presence of esophageal adenocarcinoma than typical gastroesophageal reflux symptoms. Ann Surg. 2004;239(6):849-856; discussion 856-858.

—Reviewed by Peter C. Belafsky, MD, PhD