Davison Jon M, Landau Michael S, Luketich James D, McGrath Kevin M, Foxwell Tyler J, Landsittel Douglas P, Gibson Michael K, Nason Katie S
Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Clin Gastroenterol Hepatol. 2016 Mar;14(3):369-377.e3. doi: 10.1016/j.cgh.2015.10.020. Epub 2015 Oct 26.
BACKGROUND & AIMS: It is important to identify superficial (T1) gastroesophageal adenocarcinomas (EAC) that are most or least likely to metastasize to lymph nodes, to select appropriate therapy. We aimed to develop a risk stratification model for metastasis of superficial EAC to lymph nodes using pathologic features of the primary tumor.
We collected pathology data from 210 patients with T1 EAC who underwent esophagectomy from 1996 through 2012 on factors associated with metastasis to lymph nodes (tumor size, grade, angiolymphatic invasion, and submucosal invasion). Using these variables, we developed a multivariable logistic model to generate 4 categories for estimated risk of metastasis (<5% risk, 5%-10% risk, 15%-20% risk, or >20% risk). The model was validated in a separate cohort of 39 patients who underwent endoscopic resection of superficial EAC and subsequent esophagectomy, with node stage analysis.
We developed a model based on 4 pathologic factors that determined risk of metastasis to range from 2.9% to 60% for patients in the first cohort. In the endoscopic resection validation cohort, higher risk scores were associated with increased detection of lymph node metastases at esophagectomy (P = .021). Among patients in the first cohort who did not have lymph node metastases detected before surgery (cN0), those with high risk scores (>20% risk) had 11-fold greater odds for having lymph node metastases at esophagectomy compared with patients with low risk scores (95% confidence interval, 2.3-52 fold). Increasing risk scores were associated with reduced patient survival time (P < .001) and shorter time to tumor recurrence (P < .001). Patients without lymph node metastases (pT1N0) but high risk scores had reduced times of survival (P < .001) and time to tumor recurrence (P = .001) after esophagectomy than patients with pT1N0 tumors and lower risk scores.
Pathologic features of primary superficial EACs can be used, along with the conventional node staging system, to identify patients at low risk for metastasis, who can undergo endoscopic resection, or at high risk, who may benefit from induction or adjuvant therapy.
鉴别最有可能或最不可能发生淋巴结转移的浅表性（T1期）食管腺癌（EAC）对于选择合适的治疗方法至关重要。我们旨在利用原发性肿瘤的病理特征，开发一种用于浅表性EAC淋巴结转移的风险分层模型。
我们收集了1996年至2012年期间接受食管切除术的210例T1期EAC患者的病理数据，这些数据涉及与淋巴结转移相关的因素（肿瘤大小、分级、血管淋巴管浸润和黏膜下浸润）。利用这些变量，我们建立了一个多变量逻辑模型，以生成4个估计转移风险类别（风险<5%、5%-10%、15%-20%或>20%）。该模型在另一组39例接受浅表性EAC内镜切除及随后食管切除术并进行淋巴结分期分析的患者中得到验证。
我们基于4个病理因素建立了一个模型，该模型确定第一组患者的转移风险范围为2.9%至60%。在内镜切除验证队列中，较高的风险评分与食管切除术中淋巴结转移检出率增加相关（P = 0.021）。在第一组术前未检测到淋巴结转移（cN0）的患者中，高风险评分（>20%风险）的患者与低风险评分患者相比，食管切除术中发生淋巴结转移的几率高11倍（95%置信区间，2.3 - 52倍）。风险评分增加与患者生存时间缩短（P < 0.001）和肿瘤复发时间缩短（P < 0.001）相关。与pT1N0肿瘤且风险评分较低的患者相比，无淋巴结转移（pT1N0）但风险评分高的患者食管切除术后的生存时间（P < 0.001）和肿瘤复发时间（P = 0.001）缩短。
原发性浅表性EAC的病理特征可与传统的淋巴结分期系统一起用于识别转移风险低的患者（可接受内镜切除）或转移风险高的患者（可能从诱导或辅助治疗中获益）。
