Prognostic significance of the pN classification supplemented by vascular invasion for esophageal squamous cell carcinoma.
Prognostic significance of the pN classification supplemented by vascular invasion for esophageal squamous cell carcinoma.
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pN分类辅以血管侵犯对食管鳞状细胞癌的预后意义
DOI：
10.1371/journal.pone.0096129
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Cai MY
中科院分区：
文献类型：
--
作者：
Zhu CM;Ling YH;Xi SY;Luo RZ;Chen JW;Yun JP;Xie D;Cai MY
背景食管鳞状细胞癌（ESCC）的生物学行为和临床预后难以预测。方法学/主要发现我们研究了血管浸润对预后的影响，以建立一个危险分层模型来预测复发和总生存率。我们回顾性评估了2000年至2007年在一个学术中心接受手术治疗的433例ESCC患者的血管侵犯情况。通过计算机生成的随机数将这些患者分配到测试队列和验证队列。在训练和验证队列中，分别在216例ESCC中的113例（52.3%）和217例ESCC中的96例（44.2%）中观察到血管浸润。进一步相关分析显示，两组食管鳞癌血管侵犯与pN分期及临床分期均显著相关（P<0.05）。此外，两组单因素和多因素分析显示，ESCC患者血管浸润与总生存率和无复发生存率均较低密切相关（P<0.05）。在无淋巴结转移的ESCC患者中，血管浸润也是预后的预测因素（P<0.05）。更重要的是，pN分类辅以血管浸润的联合预后模型可以显著分层两个队列中总生存期和无复发生存期的风险（低、中、高）（P<0.05）。与pN分类相比，组合模型的C指数显示出改善的预测能力（训练和验证队列分别为0.785 vs 0.739和0.689 vs 0.650; P<0.05）。结论/意义血管侵犯的检查可以作为一个额外的有效工具，在确定这些ESCC患者在肿瘤进展的风险增加。提出的新的预后模型与pN分类补充血管浸润可能会提高区分ESCC患者的结果的能力。
Background The biological behavior and clinical outcome of esophageal squamous cell carcinoma (ESCC) are difficult to predict. Methodology/Principal Findings We investigate the prognostic impact of vascular invasion to establish a risk stratification model to predict recurrence and overall survival. We retrospectively evaluated the vascular invasion of 433 patients with ESCC treated with surgery between 2000 and 2007 at a single academic center. Those patients were assigned to a testing cohort and a validation cohort by random number generated in computer. The presence of vascular invasion was observed in 113 of 216 (52.3%) and 96 of 217 (44.2%) of ESCC in the training and validation cohorts, respectively. Further correlation analysis demonstrated that vascular invasion in ESCC was significantly correlated with more advanced pN classification and stage in both cohorts (P<0.05). Additionally, presence of vascular invasion in ESCC patients was associated closely with poor overall and recurrence-free survival as evidenced by univariate and multivariate analysis in both cohorts (P<0.05). In the subset of ESCC patients without lymph node metastasis, vascular invasion was evaluated as a prognostic predictor as well (P<0.05). More importantly, the combined prognostic model with pN classification supplemented by vascular invasion can significantly stratify the risk (low, intermediate and high) for overall survival and recurrence-free survival in both cohorts (P<0.05). The C-index to the combined model showed improved predictive ability when compared to the pN classification (0.785 vs 0.739 and 0.689 vs 0.650 for the training and validation cohorts, respectively; P<0.05). Conclusions/Significance The examination of vascular invasion could be used as an additional effective instrument in identifying those ESCC patients at increased risk of tumor progression. The proposed new prognostic model with the pN classification supplemented by vascular invasion might improve the ability to discriminate ESCC patients’ outcome.
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影响因子：
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作者：
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通讯作者：
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