Abstract

Lymph node metastasis (LNM) is a key prognostic factor in esophageal squamous cell carcinoma (ESCC), and accurate preoperative prediction remains challenging. Blood biomarkers provide a conventional, preoperative diagnostic technique that is cost-effective and free from radiation risks. So far, previous studies have been published on the precise diagnosis of lymph node metastases using conventional ultrasound or CT techniques. While there is a lack of research studies that address the diagnosis of LNM from blood biomarkers. In this work, we acquired a cohort of blood biomarkers of 1933 patients and designed a weighted neural network (WNN) model for the accurate prediction of LNM from blood biomarkers. The WNN model is designed with a neural network classifier trained on blood biomarkers labeled with pathological nodal (pN) stages of LNM. The experimental findings demonstrate that the WNN model achieved 83.1% accuracy and an AUC of 0.88 on the original, non-augmented test set for diagnosing LNM, while CT only achieved 50.4% accuracy (AUC 0.60) and ultrasound achieved 60.5% accuracy (AUC 0.67). Additionally, SHAP analysis reveals that three blood biomarkers—white blood cells (WBC#), monocytes (Mono#), and neutrophils (Neut#)—significantly impact the WNN model’s output. This WNN model shows promise as a research tool to diagnose LNM.

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