Gamboa Anthony M, Kim Sungjin, Force Seth D, Staley Charles A, Woods Kevin E, Kooby David A, Maithel Shishir K, Luke Jennifer A, Shaffer Katherine M, Dacha Sunil, Saba Nabil F, Keilin Steven A, Cai Qiang, El-Rayes Bassel F, Chen Zhengjia, Willingham Field F
Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Cancer. 2016 Jul 15;122(14):2150-7. doi: 10.1002/cncr.30040. Epub 2016 May 3.
In considering treatment allocation for patients with early esophageal adenocarcinoma, the incidence of lymph node metastasis is a critical determinant; however, this has not been well defined or stratified by the relevant clinical predictors of lymph node spread.
Data from the Surveillance, Epidemiology, and End Results database of the National Cancer Institute were abstracted from 2004 to 2010 for patients with early-stage esophageal adenocarcinoma. The incidence of lymph node involvement for patients with Tis, T1a, and T1b tumors was examined and was stratified by predictors of spread.
A total of 13,996 patients with esophageal adenocarcinoma were evaluated. Excluding those with advanced, metastatic, and/or invasive (T2-T4) disease, 715 patients with Tis, T1a, and T1b tumors were included. On multivariate analysis, tumor grade (odds ratio [OR], 2.76; 95% confidence interval [95% CI], 1.58-4.82 [P<.001]), T classification (OR, 0.47; 95% CI, 0.24-0.91 [P =.025]), and tumor size (OR, 2.68; 95% CI, 1.48-4.85 [P = .001]) were found to be independently associated with lymph node metastases. There was no lymph node spread noted with Tis tumors. For patients with low-grade (well or moderately differentiated) tumors measuring <2 cm in size, the risk of lymph node metastasis was 1.7% for T1a (P<.001) and 8.6% for T1b (P = .001) tumors.
For patients with low-grade Tis or T1 tumors measuring ≤2 cm in size, the incidence of lymph node metastasis appears to be comparable to the mortality rate associated with esophagectomy. For highly selected patients with early esophageal adenocarcinomas, the results of the current study support the recommendation that local endoscopic resection can be considered as an alternative to surgical management when followed by rigorous endoscopic and radiographic surveillance. Cancer 2016;122:2150-7. © 2016 American Cancer Society.
在考虑早期食管腺癌患者的治疗分配时，淋巴结转移的发生率是一个关键决定因素；然而，这一点尚未根据淋巴结转移的相关临床预测因素进行明确界定或分层。
从美国国立癌症研究所的监测、流行病学和最终结果数据库中提取2004年至2010年早期食管腺癌患者的数据。检查Tis、T1a和T1b肿瘤患者的淋巴结受累发生率，并根据转移预测因素进行分层。
共评估了13996例食管腺癌患者。排除患有晚期、转移性和/或浸润性（T2 - T4）疾病的患者后，纳入了715例Tis、T1a和T1b肿瘤患者。多因素分析显示，肿瘤分级（比值比[OR]，2.76；95%置信区间[95%CI]，1.58 - 4.82[P <.001]）、T分类（OR，0.47；95%CI，0.24 - 0.91[P =.025]）和肿瘤大小（OR，2.68；95%CI，1.48 - 4.85[P =.001]）与淋巴结转移独立相关。Tis肿瘤未发现淋巴结转移。对于肿瘤分级低（高分化或中分化）且大小<2 cm的患者，T1a肿瘤的淋巴结转移风险为1.7%（P <.001），T1b肿瘤为8.6%（P =.001）。
对于肿瘤分级低的Tis或大小≤2 cm的T1肿瘤患者，淋巴结转移发生率似乎与食管切除术相关的死亡率相当。对于经过严格挑选的早期食管腺癌患者，本研究结果支持以下建议：在进行严格的内镜和影像学监测后，可考虑将局部内镜切除作为手术治疗的替代方法。《癌症》2016年；122:2150 - 7。©2016美国癌症协会。
