Wang Shaohua, Chen Xiaofeng, Fan Jie, Lu Lu
Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China.
Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China.
Ann Surg Oncol. 2016 Nov;23(12):4101-4109. doi: 10.1245/s10434-016-5416-8. Epub 2016 Jul 19.
This study was designed to demonstrated the prognostic significance of lymphatic and vascular invasion in thoracic esophageal squamous cell carcinoma after curative surgery and establish their predictive role for lymph node metastasis and recurrence in early-stage disease.
Clinical data of all patients from 2002 to 2014 who underwent curative surgery for thoracic squamous cell carcinoma were collected from a prospectively maintained database. The association of lymphatic invasion and vascular invasion with clinicopathological variables was illustrated respectively. The effect of lymphatic invasion and vascular invasion on the disease-free survival was determined by Kaplan-Meier analysis stratified by pathological stage. The predictive factors for lymph node metastasis in pT1 tumors and the predictive factors for recurrence in patients without lymph node involvement were analyzed with univariate and multivariate analyses respectively.
Both lymphatic invasion and vascular invasion significantly decreased stage-stratified, disease-free survival (p < 0.001). The independent predictive factors for lymph node metastasis in tumors limited in mucosa and submucosa were: submucosa invasion (p < 0.001, odds ratio [OR] 7.303), lymphatic invasion (p < 0.001, OR 5.031), and tumor differentiation (p = 0.008, OR 1.784). The independent predictive factors for decreased disease-free survival in patients with N0 disease involvement were: lymphatic invasion (p = 0.005, OR 4.326) and deeper tumor invasion (p = 0.001, OR 2.634).
Lymphatic invasion and vascular invasion are negative prognostic factors independent of tumor stage. Lymphatic invasion is a high-risk factor of lymph node metastasis in T1 tumors and a high-risk factor of recurrence in patients without lymph node involvement.
本研究旨在阐明根治性手术后胸段食管鳞状细胞癌中淋巴管和血管侵犯的预后意义，并确立其对早期疾病淋巴结转移和复发的预测作用。
从一个前瞻性维护的数据库中收集2002年至2014年所有接受胸段鳞状细胞癌根治性手术患者的临床资料。分别阐述淋巴管侵犯和血管侵犯与临床病理变量的相关性。通过按病理分期分层的Kaplan-Meier分析确定淋巴管侵犯和血管侵犯对无病生存期的影响。分别采用单因素和多因素分析pT1肿瘤中淋巴结转移的预测因素以及无淋巴结受累患者复发的预测因素。
淋巴管侵犯和血管侵犯均显著降低了按分期分层的无病生存期（p<0.001）。局限于黏膜和黏膜下层肿瘤的淋巴结转移独立预测因素为：黏膜下层侵犯（p<0.001，比值比[OR]7.303）、淋巴管侵犯（p<0.001，OR 5.031）和肿瘤分化程度（p = 0.008，OR 1.784）。无N0疾病受累患者无病生存期降低的独立预测因素为：淋巴管侵犯（p = 0.005，OR 4.326）和肿瘤侵犯更深（p = 0.001，OR 2.634）。
淋巴管侵犯和血管侵犯是独立于肿瘤分期的不良预后因素。淋巴管侵犯是T1肿瘤淋巴结转移的高危因素，也是无淋巴结受累患者复发的高危因素。
