Clinicopathologic Features of Submucosal Esophageal Squamous Cell Carcinoma
Clinicopathologic Features of Submucosal Esophageal Squamous Cell Carcinoma
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DOI：
10.1016/j.athoracsur.2017.06.037
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发表时间：
2017-12-01
影响因子：
4.6
通讯作者：
Okada, Morihito
中科院分区：
文献类型：
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作者：
Emi, Manabu;Hihara, Jun;Okada, Morihito
背景资料。粘膜下食管鳞癌患者的预后各不相同。预后良好的患者可能会接受侵入性较小的或非手术干预，而预后较差或晚期食道癌的患者可能需要积极的治疗。我们试图找出影响粘膜下食管鳞癌患者预后的因素，重点放在淋巴结转移和复发上。我们包括137例黏膜下食管鳞癌患者，他们接受了经胸食道切除术和系统性扩大淋巴清扫术。黏膜下肿瘤按侵袭深度分为SM1、SM2和SM3。通过单因素和多因素分析确定预后因素。SM1、SM2和SM3的淋巴结转移率分别为18.8%、30.5%和50.0%。总的5年复发率为21.9%，SM1、SM2和SM3肿瘤的复发率分别为9.4%、18.6%和34.8%。SM1肿瘤均为局部复发，SM2和SM3例发生远处转移。SM1、SM2和SM3的5年总生存率分别为83%、77%和59%。在单变量分析中，淋巴结转移、粘膜下侵犯深度(SM3比SM1/2)和肿瘤部位(上胸与中/下胸)是影响总生存率的不良预后因素。多变量Cox回归分析显示，黏膜下侵犯深度(危险比2.51，95%可信区间：1.37~4.61)和肿瘤部位(危险比2.43，95%可信区间：1.18~4.63)是影响手术前预后的因素。肿瘤部位(上胸)和浸润性(SM3)是粘膜下食管鳞癌预后较差的因素，但淋巴结转移不是预后较差的因素。(C)2017年，由胸外科医生学会主办
Background. The prognoses of submucosal esophageal squamous cell carcinoma patients vary. Patients with favorable prognoses may receive less invasive or nonsurgical interventions, whereas patients with poor prognoses or advanced esophageal cancer may require aggressive treatments. We sought to identify prognostic factors for patients with submucosal esophageal squamous cell carcinoma, focusing on lymph node metastasis and recurrence.Methods. We included 137 submucosal esophageal squamous cell carcinoma patients who had undergone transthoracic esophagectomy with systematic extended lymph node dissection. Submucosal tumors were classified as SM1, SM2, and SM3 according to the depth of invasion. Prognostic factors were determined by univariable and multivariable analyses.Results. Lymph node metastasis was observed in 18.8%, 30.5%, and 50.0% of SM1, SM2, and SM3 cases, respectively. The overall 5-year recurrence rate was 21.9%; the rates for SM1, SM2, and SM3 tumors were 9.4%, 18.6%, and 34.8%, respectively. The SM1 tumors all recurred locoregionally; distant metastasis occurred in SM2 and SM3 cases. The 5-year overall survival rates were 83%, 77%, and 59% for SM1, SM2, and SM3 cases, respectively. On univariable analysis, lymph node metastasis, depth of submucosal invasion (SM3 versus SM1/2), and tumor location (upper thoracic versus mid/lower thoracic) were poor prognostic factors for overall survival. Multivariable Cox regression analyses identified depth of submucosal invasion (hazard ratio 2.51, 95% confidence interval: 1.37 to 4.61) and tumor location (hazard ratio 2.43, 95% confidence interval: 1.18 to 4.63) as preoperative prognostic factors.Conclusions. Tumor location (upper thoracic) and infiltration (SM3) are the worse prognostic factors of submucosal esophageal squamous cell carcinoma, but lymph node metastasis is not a predictor of poorer prognosis. (C) 2017 by The Society of Thoracic Surgeons