Prediction of Lymph Node Status in Superficial Esophageal Carcinoma
Prediction of Lymph Node Status in Superficial Esophageal Carcinoma
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DOI：
10.1245/s10434-008-0065-1
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发表时间：
2008-11-01
影响因子：
3.7
通讯作者：
Rugge, Massimo
中科院分区：
文献类型：
--
作者：
Ancona, Ermanno;Rampado, Sabrina;Rugge, Massimo
背景：食管癌是预后最差的癌症之一。真正的治愈机会取决于早期发现和早期治疗。预测淋巴结受累的能力允许用更小的侵入性方法进行早期治疗。目的：确定与早期食管癌（T1）患者淋巴结累及相关的临床组织病理学标准，并确定局部内镜或微创手术治疗的最佳候选患者。方法：1980年至2006年，我院共98例pT1食管癌患者（67例为鳞状细胞癌，31例为腺癌）行Ivor-Lewis或McKeown食管切除术。根据浸润深度，将粘膜病变分为m1、m2或m3，粘膜下病变分为sm1、sm2或sm3。结果：27例粘膜癌（T1m）的淋巴结转移率为0%，71例粘膜下癌（T1sm）的淋巴结转移率为28% （P < 0.001）。Sm1癌与较低的淋巴结转移率相关（8.3%对49% sm2/3， P = 0.003）。在组织类型方面，sm1的淋巴结转移率在ADK中为0%，在SCC中为12.5%；sm2/3无显著性差异。在多变量分析中，浸润深度、淋巴细胞浸润、血管淋巴和神经浸润与淋巴结受累显著相关。神经侵犯是准确率最高的单一参数（82%）；浸润深度和血管淋巴浸润准确率为75%。这三个参数的准确率为97%。总体5年生存率为56.7%，其中T1m为77.7%，T1sm为53.3% （P = 0.048）。结论：预测早期食管癌淋巴结转移最重要的因素是肿瘤浸润深度、血管淋巴浸润程度、神经浸润程度和淋巴细胞浸润程度。内镜治疗的最佳候选肿瘤是高度淋巴细胞浸润，无血管淋巴或神经浸润，粘膜浸润或sm1（仅适用于ADK），肿瘤大小< 1cm。对于sm型SCC和sm2/3型ADK，选择的治疗方法仍然是食管切除术加标准淋巴结切除术。
Background: Esophageal carcinoma is among the cancers with the worst prognosis. Real chances for cure depend on both early recognition and early treatment. The ability to predict lymph node involvement allows early curative treatment with less invasive approaches.Aims: To determine clinicohistopathological criteria correlated with lymph node involvement in patients with early esophageal cancer (T1) and to identify the best candidate patients for local endoscopic or less invasive surgical treatments.Methods: A total of 98 patients with pT1 esophageal cancer [67 with squamous cell carcinomas (SCC) and 31 with adenocarcinomas (ADK)] underwent Ivor-Lewis or McKeown esophagectomy in the period between 1980 and 2006 at our institution. Based on the depth of invasion, lesions were classified as m1, m2, or m3 if mucosal, and sm1, sm2, or sm3 if submucosal.Results: The rates of lymph node metastasis were 0% for the 27 mucosal carcinomas (T1m) and 28% for the 71 submucosal (T1sm) carcinomas (P < 0.001). Sm1 carcinomas were associated with a lower rate of lymph-node metastasis (8.3% versus 49% sm2/3, P = 0.003). As for histotype, the rates of lymph node metastasis for sm1 were 0% for ADK and 12.5% for SCC; for sm2/3 there were no significant differences. On multivariate analysis, depth of infiltration, lymphocytic infiltrate, angiolymphatic and neural invasion were significantly associated with lymph node involvement. Neural invasion was the single parameter with the greatest accuracy (82%); depth of infiltration and angiolymphatic invasion had 75% accuracy. Altogether these three parameters had an accuracy of 97%. Five-year survival rate was 56.7% overall: 77.7% for T1m and 53.3% for T1sm (P = 0.048).Conclusions: The most important factors for predicting lymph node metastasis in early esophageal cancer are depth of tumor infiltration, angiolymphatic invasion, neural invasion and grade of lymphocytic infiltration. The best candidates for endoscopic therapy are tumors with high-grade lymphocytic infiltration, no angiolymphatic or neural invasion, mucosal infiltration or sm1 (only for ADK), and tumor < 1 cm in size. For sm SCC and sm2/3 ADK the treatment of choice remains esophagectomy with standard lymphadenectomy.