Seder Christopher W, Mahon Brett, Hennon Mark, Thomas Mathew, Levea Charles M, Matkowskyj Kristina A, Krishna Murli, Medairos Robert, Macke Ryan A, Basu Sanjib, Blasberg Justin D
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, U.S.A.
Pathology, Rush University Medical Center, Chicago, IL, U.S.A.
Anticancer Res. 2018 Apr;38(4):2195-2200. doi: 10.21873/anticanres.12461.
Although tumor depth of invasion is strongly associated with risk of lymph node metastasis and long-term survival in patients with esophageal adenocarcinoma, the significance of differential T2 invasion (inner circular layer versus outer longitudinal layer) is unknown. The current study was undertaken to explore the hypothesis that greater T2-specific depth of invasion is associated with inferior long-term outcomes in patients with esophageal adenocarcinoma treated with esophagectomy.
Demographic, treatment, and outcome data were collected for patients with resected pT2N0-3M0 esophageal adenocarcinoma treated between 2005 and 2015 pooled from four U.S. academic medical centers. Two blinded pathologists evaluated depth of muscularis propria tumor invasion. Univariate and Cox proportional hazard regression analyses were performed to identify prognostic factors for overall (OS) and disease-free (DFS) survival, and Kaplan-Meier analysis to compare survival differences specific to prognostic factors.
A total of 84 patients were identified for analysis (53 with circular invasion; 31 with longitudinal invasion), with a median age of 66 years. Sixty percent of patients (50/84) received induction therapy prior to esophagectomy. The median OS and DFS was 58 months (95% confidence interval(CI)=42 months-not reached) and 27 months (95% CI=13.7-66 months) respectively. Depth of muscularis propria invasion did not correlate with OS or DFS on univariate (p=0.42; and p=0.34, respectively) or multivariate (p=0.15 and p=0.21, respectively) analysis after adjustment for age, nodal status, perineural invasion, and tumor grade. These findings did not vary by induction therapy status.
Depth of muscularis propria invasion does not appear to correlate with survival in patients with esophageal adenocarcinoma.
尽管肿瘤浸润深度与食管腺癌患者的淋巴结转移风险和长期生存密切相关，但T2期不同浸润深度（内环层与外纵层）的意义尚不清楚。本研究旨在探讨这一假说，即食管腺癌患者接受食管切除术后，T2期特异性浸润深度越深，长期预后越差。
收集2005年至2015年间在美国四个学术医疗中心接受手术切除的pT2N0-3M0食管腺癌患者的人口统计学、治疗及预后数据。两名病理学家在不知情的情况下评估固有肌层肿瘤浸润深度。进行单因素和Cox比例风险回归分析，以确定总生存（OS）和无病生存（DFS）的预后因素，并采用Kaplan-Meier分析比较特定预后因素的生存差异。
共纳入84例患者进行分析（53例为环状浸润；31例为纵行浸润），中位年龄66岁。60%的患者（50/84）在食管切除术前接受了诱导治疗。中位OS和DFS分别为58个月（95%置信区间[CI]=42个月-未达到）和27个月（95%CI=13.7-66个月）。在对年龄、淋巴结状态、神经周围浸润和肿瘤分级进行校正后，单因素分析（p分别为0.42和0.34）及多因素分析（p分别为0.15和0.21）显示，固有肌层浸润深度与OS或DFS均无相关性。这些结果不受诱导治疗状态的影响。
食管腺癌患者的固有肌层浸润深度似乎与生存无关。
