Dubecz Attila, Kern Marcus, Solymosi Norbert, Schweigert Michael, Stein Hubert J
Department of Surgery, Private Medical University Nürnberg, Nuremberg, Germany.
Department of Surgery, Private Medical University Nürnberg, Nuremberg, Germany.
Ann Thorac Surg. 2015 Jun;99(6):1879-85; discussion 1886. doi: 10.1016/j.athoracsur.2015.02.112. Epub 2015 Apr 28.
The application of endoscopic therapies for early cancers of the esophagus is limited by the possible presence of regional lymph node metastases. Our objective was to determine the prevalence and predictors of lymph node metastases in patients with pT1 carcinoma of the esophagus and the gastric cardia.
The National Cancer Institute's Surveillance Epidemiology and End Results Database (2004 to 2010) was used to identify all patients with pT1 carcinomas who underwent primary surgical resection for squamous cell carcinoma (SCC) or adenocarcinoma (EAC) of the esophagus and of the esophagogastric junction (AEG). Prevalence of lymph node metastases was assessed, and survival in all types of cancer was calculated. Multivariate logistic regression was used to identify factors predicting positive lymph node status.
There were 1,225 patients (84% male), with a mean age of 64 ± 10 years, and 90% were white. Intramucosal disease was present in 44% of patients, and submucosal invasion (T1b) was present in 692 (56%). Prevalence of lymph node metastases in EAC, SCC, and AEG was 6.4%, 6.9%, and 9.5% for pT1a tumors and 19.6%, 20%, and 22.9% for pT1b tumors, respectively. In patients with more than 23 lymph nodes removed during resection, prevalence of lymph node metastases in EAC, SCC, and AEG was 8.1%, 25%, and 7.4% for pT1a tumors and 27.8%, 33.3%, and 22% for pT1b tumors, respectively. Positive lymph node status was associated with worse overall 5-year survival in EAC (N0 vs N+: 78% vs 52%) and AEG (N0 vs N+: 83% vs 44%) but did not have a significant effect on the long-term survival of patients with SCC. Infiltration of the submucosa, tumor size exceeding 10 mm, and poor tumor differentiation were independently associated with the risk of nodal disease. Prevalence of lymph node metastasis negative for these three risk factors was only 4.8%.
Prevalence of lymph node metastasis in early esophageal cancer is high in patients with T1 cancer. Inadequate lymphadenectomy underestimates lymph node status. Endoscopic treatment can be considered only in a select group of patients with early esophageal cancer.
内镜治疗早期食管癌受到区域淋巴结转移可能性的限制。我们的目的是确定食管及贲门pT1期癌患者淋巴结转移的发生率及预测因素。
利用美国国立癌症研究所的监测、流行病学和最终结果数据库（2004年至2010年），确定所有因食管鳞状细胞癌（SCC）或腺癌（EAC）以及食管胃交界腺癌（AEG）接受初次手术切除的pT1期癌患者。评估淋巴结转移的发生率，并计算所有类型癌症患者的生存率。采用多因素逻辑回归分析确定预测淋巴结阳性状态的因素。
共有1225例患者（84%为男性），平均年龄64±10岁，90%为白人。44%的患者为黏膜内病变，692例（56%）患者存在黏膜下浸润（T1b）。pT1a期肿瘤中，EAC、SCC和AEG的淋巴结转移发生率分别为6.4%、6.9%和9.5%；pT1b期肿瘤分别为19.6%、20%和22.9%。在切除术中切除超过23枚淋巴结的患者中，pT1a期肿瘤的EAC、SCC和AEG淋巴结转移发生率分别为8.1%、25%和7.4%；pT1b期肿瘤分别为27.8%、33.3%和22%。淋巴结阳性状态与EAC（N0 vs N+：78% vs 52%）和AEG（N0 vs N+：83% vs 44%）患者较差的5年总生存率相关，但对SCC患者的长期生存无显著影响。黏膜下浸润、肿瘤大小超过10mm以及肿瘤分化差与淋巴结转移风险独立相关。这三个危险因素淋巴结转移阴性的发生率仅为4.8%。
T1期食管癌患者早期淋巴结转移发生率较高。淋巴结清扫不充分会低估淋巴结状态。内镜治疗仅可考虑用于特定的早期食管癌患者群体。
