*Departments of Surgery †Pathology, and ‡Gastroenterology, Dr Horst-Schmidt-Klinik, Wiesbaden, Germany; and §Department of Pathology, Klinikum Kulmbach, Germany.
Ann Surg. 2014 Mar;259(3):469-76. doi: 10.1097/SLA.0000000000000217.
To define prognostic risk factors in patients with early adenocarcinomas of the esophagus (eACEs) who were treated by esophagectomy.
Although endoscopic resection (ER) is more accepted for eACEs limited to the mucosa, the reported prevalence of lymph node metastases once the tumor infiltrates the submucosa seems to necessitate surgery in these cases.
We analyzed the results of 168 patients who had an esophageal resection because of an eACE. On the basis of specimen histologies and clinical follow-up (median, 64 months), we investigated the influence of lymph node metastases (N+), tumor infiltration depth, tumor differentiation (G1-3), and lymphatic or venous infiltration (L+ or V+) on overall and tumor-specific survival and recurrence rates.
The 5-year survival rate was 79%. Lymph node infiltration was the only prognostic factor for the overall survival [hazard ratio (HR), 2.856; 1.314-6.207; P = 0.008], tumor-specific survival (HR, 8.336; 2.734-25.418; P < 0.001), and tumor recurrence (HR, 8.031; 3.041-21.206; P < 0.001) that was consistently present in all multivariate hazard Cox regression analyses. A total of 47% of the patients who had an N+ status developed tumor recurrences compared with 5.2% of those who had no lymph node involvement (P = <0.001). We found a significant correlation between N+ status and increasing depth of tumor infiltration (P = 0.004), lymphatic vessel infiltration (P = 0.002), tumor differentiation (G1 + G2 vs G3; P = 0.014) and vascular infiltration (P = 0.01).
Lymph node status is the only independent risk factor for survival and recurrence rates. Tumor infiltration depth correlates with the rate of the lymph node metastases, but a clear watershed between deep mucosal and submucosal infiltration does not exist. As a consequence, careful staging procedures, including diagnostic ER, are mandatory to determine which patients can be treated by ER and which require an esophagectomy.
定义接受食管切除术治疗的早期食管腺癌（eACE）患者的预后危险因素。
尽管内镜下切除（ER）更适用于局限于黏膜的 eACE，但肿瘤浸润黏膜下后报告的淋巴结转移率似乎需要对此类病例进行手术。
我们分析了 168 例因 eACE 而行食管切除术患者的结果。根据标本组织学和临床随访（中位数 64 个月），我们研究了淋巴结转移（N+）、肿瘤浸润深度、肿瘤分化（G1-3）、淋巴管或静脉浸润（L+或 V+）对总生存率、肿瘤特异性生存率和复发率的影响。
5 年生存率为 79%。淋巴结浸润是总生存率的唯一预后因素[风险比（HR），2.856；1.314-6.207；P=0.008]、肿瘤特异性生存率（HR，8.336；2.734-25.418；P<0.001）和肿瘤复发（HR，8.031；3.041-21.206；P<0.001），所有多变量风险 Cox 回归分析中均存在该因素。N+状态的患者中有 47%发生肿瘤复发，而无淋巴结受累的患者中只有 5.2%发生肿瘤复发（P<0.001）。我们发现 N+状态与肿瘤浸润深度增加（P=0.004）、淋巴管浸润（P=0.002）、肿瘤分化（G1+G2 与 G3；P=0.014）和血管浸润（P=0.01）显著相关。
淋巴结状态是生存率和复发率的唯一独立危险因素。肿瘤浸润深度与淋巴结转移率相关，但黏膜下深层浸润与黏膜下浅层浸润之间不存在明显的分水岭。因此，需要仔细进行分期操作，包括诊断性 ER，以确定哪些患者可以通过 ER 治疗，哪些患者需要进行食管切除术。
