Esophageal carcinoma: Depth of tumor invasion is predictive of regional lymph node status
Esophageal carcinoma: Depth of tumor invasion is predictive of regional lymph node status
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DOI：
10.1016/s0003-4975(97)01387-8
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发表时间：
1998-03-01
影响因子：
4.6
通讯作者：
Goldblum, JR
中科院分区：
文献类型：
--
作者：
Rice, TW;Zuccaro, G;Goldblum, JR
背景。肿瘤浸润深度（T）和区域淋巴结状态（N）是确定食管癌分期的两个因素。然而，分期组的划分假定这些因素是独立变量。对359例连续接受食管切除术的患者进行回顾性研究，以明确T和N之间的关系，并确定T是否是区域淋巴结转移（N1）的重要预测因素。
方法。主要治疗方法是未进行术前治疗的手术。其中有295例（82%）腺癌、55例（15%）鳞状细胞癌和9例（3%）腺鳞癌。T状态为：29例（8%）患者为Tis，65例（18%）为T1，37例（10%）为T2，219例（61%）为T3，9例（3%）为T4。N状态为：161例（45%）患者为N0，198例（55%）为N1。M状态为：327例（91%）患者为M0，32例（9%）为M1。分期为：29例（8%）患者为0期，58例（16%）为I期，70例（20%）为IIA期，22例（6%）为IIB期，148例（41%）为III期，32例（9%）为IV期。
结果。使用趋势检验测试随着T增加发生N1疾病的可能性。N1疾病患者的百分比在Tis为0%，T1为11%，T2为43%，T3为77%，T4为67%（p < 0.001）。这种关系在腺癌和鳞状细胞癌中均存在。多变量分析确定T增加、腺癌以及缺乏高分化组织学特征是N1疾病的重要预测因素。与T1患者相比，T2患者发生N1疾病的可能性高6倍，T3患者高23倍，T4患者高35倍。
结论。我们得出结论，对于食管癌患者，T是N的重要预测因素，这种关联应与临床分期和治疗决策中使用的其他既定因素一起考虑。
Background. The depth of tumor invasion (T) and regional lymph node status (N) are two factors that define the stage of an esophageal carcinoma. However, the arrangement of staging groups assumes that these factors are independent variables. A retrospective review of 359 consecutive patients undergoing esophageal resection was conducted to define the relationship between T and N and to determine whether T is a significant predictor of regional lymph node metastasis (N1).Methods. Primary treatment was operation without preoperative therapy. There were 295 (82%) adenocarcinomas, 55 (15%) squamous cell carcinomas, and 9 (3%) adenosquamous carcinomas. T status was Tis in 29 (8%) patients, T1 in 65 (18%), T2 in 37 (10%), T3 in 219 (61%), and T4 in 9 (3%). N status was NO in 161 (45%) patients and N1 in 198 (55%). M status was MO in 327 (91%) patients and M1 in 32 (9%). Stage was 0 in 29 (8%) patients, I in 58 (16%), IIA in 70 (20%), IIB in 22 (6%), III in 148 (41%), and IV in 32 (9%).Results, The likelihood of N1 disease occurring with increasing T was tested using the trend test. The percentage of patients with N1 disease is 0% for Tis, 11% for T1, 43% for T2, 77% for T3, and 67% for T4 (p < 0.001). This relationship existed for both adenocarcinoma and squamous cell carcinoma. Multivariable analysis identified increasing T, adenocarcinoma, and lack of well-differentiated histologic features as significant predictors of N1 disease. Compared with a T1 patient, a T2 patient is 6 times more likely to have N1 disease, a T3 patient 23 times, and a T4 patient 35 times.Conclusions. We conclude that for patients with esophageal carcinoma, T is an important predictor of N and this association should be included with other established factors used in clinical staging and treatment decisions.