A Model Based on Pathologic Features of Superficial Esophageal Adenocarcinoma Complements Clinical Node Staging in Determining Risk of Metastasis to Lymph Nodes
A Model Based on Pathologic Features of Superficial Esophageal Adenocarcinoma Complements Clinical Node Staging in Determining Risk of Metastasis to Lymph Nodes
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DOI：
10.1016/j.cgh.2015.10.020
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发表时间：
2016-03-01
影响因子：
12.6
通讯作者：
Nason, Katie S.
中科院分区：
文献类型：
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作者：
Davison, Jon M.;Landau, Michael S.;Nason, Katie S.
背景与目的：识别最可能或最不可能转移到淋巴结的浅表性（T1）胃食管腺癌（EAC），选择合适的治疗方法是很重要的。我们的目的是利用原发肿瘤的病理特征，建立浅表EAC转移到淋巴结的风险分层模型。方法：我们收集了1996年至2012年期间接受食管切除术的210例T1 EAC患者的病理资料，包括与淋巴结转移相关的因素（肿瘤大小、分级、血管淋巴浸润和粘膜下浸润）。使用这些变量，我们建立了一个多变量逻辑模型，以产生4类估计转移风险（20%风险）。该模型在39例接受内镜下浅表EAC切除术和随后的食管切除术的患者中进行了验证，并进行了淋巴结分期分析。结果：我们建立了一个基于4个病理因素的模型，确定了第一队列患者转移风险在2.9%至60%之间。在内镜切除验证队列中，较高的风险评分与食管切除术中淋巴结转移的检出率增加相关（P = 0.021）。在第一组术前未发现淋巴结转移的患者（cN0）中，高风险评分（bb0 20%风险）的患者在食管切除术中发生淋巴结转移的几率比低风险评分的患者高11倍（95%置信区间，2.3-52倍）。风险评分增加与患者生存时间缩短（P < 0.001）和肿瘤复发时间缩短（P < 0.001）相关。无淋巴结转移（pT1N0）但风险评分较高的患者食管切除术后的生存时间（P < 0.001）和肿瘤复发时间（P = 0.001）均低于pT1N0且风险评分较低的患者。结论：原发性浅表EACs的病理特征可以与传统的淋巴结分期系统一起用于识别转移风险低的患者，这些患者可以接受内镜切除，或高风险的患者，他们可能受益于诱导或辅助治疗。
BACKGROUND & AIMS: It is important to identify superficial (T1) gastroesophageal adenocarcinomas (EAC) that are most or least likely to metastasize to lymph nodes, to select appropriate therapy. We aimed to develop a risk stratification model for metastasis of superficial EAC to lymph nodes using pathologic features of the primary tumor.METHODS: We collected pathology data from 210 patients with T1 EAC who underwent esophagectomy from 1996 through 2012 on factors associated with metastasis to lymph nodes (tumor size, grade, angiolymphatic invasion, and submucosal invasion). Using these variables, we developed a multivariable logistic model to generate 4 categories for estimated risk of metastasis (20% risk). The model was validated in a separate cohort of 39 patients who underwent endoscopic resection of superficial EAC and subsequent esophagectomy, with node stage analysis.RESULTS: We developed a model based on 4 pathologic factors that determined risk of metastasis to range from 2.9% to 60% for patients in the first cohort. In the endoscopic resection validation cohort, higher risk scores were associated with increased detection of lymph node metastases at esophagectomy (P = .021). Among patients in the first cohort who did not have lymph node metastases detected before surgery (cN0), those with high risk scores (>20% risk) had 11-fold greater odds for having lymph node metastases at esophagectomy compared with patients with low risk scores (95% confidence interval, 2.3-52 fold). Increasing risk scores were associated with reduced patient survival time (P < .001) and shorter time to tumor recurrence (P < .001). Patients without lymph node metastases (pT1N0) but high risk scores had reduced times of survival (P < .001) and time to tumor recurrence (P = .001) after esophagectomy than patients with pT1N0 tumors and lower risk scores.CONCLUSIONS: Pathologic features of primary superficial EACs can be used, along with the conventional node staging system, to identify patients at low risk for metastasis, who can undergo endoscopic resection, or at high risk, who may benefit from induction or adjuvant therapy.