Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases
Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases
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DOI：
10.1038/modpathol.3800557
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发表时间：
2006-03-01
期刊：
影响因子：
7.5
通讯作者：
Umemura, S
中科院分区：
文献类型：
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作者：
Eguchi, T;Nakanishi, Y;Umemura, S
以前没有关于食管浅表鳞状细胞癌淋巴结转移（LNM）的报告提出了内镜粘膜切除术（EMR）后额外治疗的明确标准。我们研究了464例接受根治性食管切除术和淋巴结清扫术的食管浅表鳞状细胞癌患者的组织病理学因素与淋巴结转移之间的关系（14个“M1”病变：上皮内肿瘤，36个“M2”病变：肿瘤侵入固有层，50个“M3”病变：与粘膜肌层接触或侵犯粘膜肌层的肿瘤，32个“SM 1”病变：肿瘤侵犯最浅的1/3粘膜下层，332个“SM 2/3”病变：肿瘤侵犯比SM 1水平更深）。我们评估了82个M3或SM 1病灶的组织学因素，包括浸润深度、大小、淋巴浸润（LY）、静脉浸润、肿瘤分化、生长模式、核浸润程度和组织学分级，以确定哪些患者在EMR后需要额外治疗。在M1、M2、M3、SM 1和SM 2/3病灶中，LNM的检出率分别为0.0%、5.6%、18.0%、53.1%和53.9%。单因素分析显示，以下组织病理学因素对LNM有显著影响：浸润深度（M3 vs SM 1）、LY、静脉浸润和组织学分级。在多因素分析中，浸润深度和LY与LNM显著相关。38例无LY的M3病变患者中有4例（10.3%）有LNM，而12例有M3病变和LY的患者中有5例（41.7%）有LNM。只有M1/2病变的患者才是EMR的良好候选人。浸润粘膜肌层（M3）与粘膜下浸润一样，是LNM的高危状态，但无LY的M3病变可在EMR后随访，无需任何额外治疗。
No previous reports on lymph-node metastasis (LNM) from superficial squamous cell carcinoma of the esophagus have proposed definite criteria for additional treatment after endoscopic mucosal resection (EMR). We investigated the association between histopathological factors and LNM in 464 consecutive patients with superficial squamous cell carcinoma of the esophagus who had undergone a radical esophagectomy with lymph-node dissection ( 14 'M1' lesions: intraepithelial tumors, 36 'M2' lesions: tumors invading the lamina propria, 50 'M3' lesions: tumors in contact with or invading the muscularis mucosa, 32 'SM1' lesions: tumors invading the most superficial 1/3 of the submucosa and 332 'SM2/3' lesions: tumors invading deeper than SM1 level). Histopathological factors including invasion depth, size, lymphatic invasion (LY), venous invasion, tumor differentiation, growth pattern, degree of nuclear atypia and histological grade were assessed for their association with LNM in 82 M3 or SM1 lesions to determine which patients need additional treatment after EMR. LNM was found in 0.0, 5.6, 18.0, 53.1 and 53.9% of the M1, M2, M3, SM1 and SM2/3 lesions, respectively. A univariate analysis showed that each of the following histopathological factors had a significant influence on LNM: invasion depth ( M3 vs SM1), LY, venous invasion and histological grade. Invasion depth and LY were significantly associated with LNM in a multivariate analysis. Four out of 38 patients (10.3%) with M3 lesions without LY had LNM, whereas five out of 12 patients (41.7%) with M3 lesions and LY had LNM. Only patients with M1/2 lesions are good candidates for EMR. Invading the muscularis mucosa ( M3) is a high-risk condition for LNM the same as submucosal invasion, but M3 lesions without LY can be followed up after EMR without any additional treatment.