Prediction of hematogenous recurrence in patients with esophageal carcinoma.
Prediction of hematogenous recurrence in patients with esophageal carcinoma.
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DOI：
10.1007/bf02736700
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发表时间：
2003-11-01
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影响因子：
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通讯作者：
Kuwano, Hiroyuki
中科院分区：
文献类型：
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作者：
Kato, Hiroyuki;Miyazaki, Tatsuya;Kuwano, Hiroyuki
目的：尽管最近食管癌的诊断和治疗取得了进展，但未来血液复发的风险仍然是不可预测的。为了确定食管癌血行性复发的危险因素，我们使用病理和免疫组织化学分析来检查临床结局、临床病理特征和E-cadherin表达之间的关系。方法：研究对象为102例未经术前治疗行根治性食管切除术的胸段食管癌患者。我们使用单变量和多变量逻辑回归分析来检验临床结果、临床病理特征和E-cadherin表达之间的关系。结果：E-cadherin的表达与手术时临床病理特征无明显关系。而e -cadherin阴性肿瘤患者的生存率明显低于e -cadherin弱和e -cadherin阳性肿瘤患者（P < 0.01）。分析102例患者时，49例（48.0%）出现疾病复发，29例（28.4%）出现血液性复发。肝转移14例，肺转移13例，骨转移6例，脑转移2例。通过多变量回归分析比较血液病复发与临床病理特征，发现血液病复发之间存在显著相关性；尤其是肝和肺转移和E-cadherin表达阴性。关于与复发的器官和阳性淋巴结数量之间的关系；血源性复发，等于或高于淋巴性复发，在阳性淋巴结数量多的患者中更容易发生。有趣的是，就阳性淋巴结的位置而言，肝转移与胸中部的淋巴结转移密切相关，而不是腹部。此外，肺转移最可能发生在颈部淋巴结转移的患者。结论：食管癌E-cadherin阴性表达倾向于与血行性复发相关，尤其是肝和肺转移。血源性复发与阳性淋巴结的数量和位置以及淋巴性复发显著相关。
OBJECTIVES: Despite recent advances in diagnosis and treatment of esophageal carcinoma, the future risk of hematogenous recurrence is still unpredictable. To identify risk factors of hematogenous recurrence in esophageal carcinoma, we used pathological and immunohistochemical analysis to examine relationships among clinical outcomes, clinicopathological features, and E-cadherin expression.METHODS: Subjects were 102 patients with thoracic esophageal cancer who had undergone curative esophagectomy without preoperative treatment. We used univariate and multivariate logistic regression analyses to examine the relationship among clinical outcomes, clinicopathological features, and E-cadherin expression.RESULTS: There was no significant relationship between E-cadherin expression and clinicopathological features at operation. However, the survival rates of patients with E-cadherin-negative tumors were significantly lower than those of patients with E-cadherin-weak and E-cadherin-positive tumors (P < 0.01). Disease recurrence had occurred in 49 (48.0%), with hematogenous recurrence in 29 (28.4%), of the 102 patients at the time of analysis. Metastasis occurred in liver in 14 patients, lung in 13, bone in 6, and brain in 2. Comparisons of hematogenous recurrences and clinicopathological features by multivariate regression analyses revealed significant associations between hematogenous recurrences; particularly in liver and lung metastasis and negative E-cadherin expression. With regard to the associations between the organ with the recurrence and the number of positive nodes; hematogenous recurrence, equal to or higher than lymphatic recurrence, was more likely to have occurred in patients with high numbers of positive nodes. Interestingly, with regard to the sites of positive nodes, liver metastasis was closely correlated with lymph node metastasis in the mid-thoracic as opposed to the abdominal region. Further, lung metastasis was most likely to occur in patients with cervical lymph node metastasis.CONCLUSIONS: Esophageal carcinoma with negative E-cadherin expression tended to be associated with hematogenous recurrence, particularly with liver and lung metastasis. Hematogenous recurrences were significantly associated with high numbers and the site of positive nodes, as well as with lymphatic recurrence.