Department of Surgery, Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Surgery, Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Surgery, Division of GI Surgery, University of North Carolina, Chapel Hill, North Carolina.
Ann Thorac Surg. 2018 Jul;106(1):172-177. doi: 10.1016/j.athoracsur.2018.02.087. Epub 2018 Apr 5.
Induction therapy has not been proven to be beneficial for patients with clinical T2N0 esophageal adenocarcinoma. Surgery alone is associated with disappointing survival for patients found to have nodal disease on final pathologic examination. The aim of this study was to identify factors that predict pathologic nodal involvement in patients with endoscopic ultrasound (EUS)-proven T2N0 esophageal adenocarcinoma.
We retrospectively reviewed patients with EUS-staged T2N0 (uT2N0) esophageal adenocarcinoma treated with surgery alone. Final pathologic staging was compared with clinical staging. Demographic and clinicopathologic variables were evaluated as putative risk factors for nodal metastases. Logistic regression models were used to identify factors associated with nodal involvement. Kaplan-Meier analysis was performed to compare overall and recurrence-free survival between patients with (N+) and without (N-) nodal disease.
We identified 80 patients with uT2N0 esophageal adenocarcinoma treated with surgery alone. Clinical staging with EUS was inaccurate for 73 patients (91%). Twenty-eight patients (35%) had pathologic N+ disease at resection. Five-year overall survival was 67% for N- patients and 41% for N+ patients (p = 0.006). Recurrence-free survival was 65% for N- patients and 32% for N+ patients (p = 0.0043). Univariable analysis identified vascular invasion and neural invasion as risk factors for nodal metastasis. Multivariable analysis identified vascular invasion as an independent predictor of pathologic nodal involvement.
EUS is inaccurate for staging of T2N0 esophageal adenocarcinoma and often fails to identify nodal involvement. Identification of vascular invasion on preoperative biopsy should be explored as a prognostic marker to select patients for induction therapy.
诱导治疗并未被证明对临床 T2N0 食管腺癌患者有益。对于最终病理检查发现淋巴结疾病的患者，单独手术与令人失望的生存相关。本研究旨在确定预测内镜超声 (EUS) 证实的 T2N0 食管腺癌患者病理淋巴结受累的因素。
我们回顾性分析了单独接受手术治疗的 EUS 分期 T2N0 (uT2N0) 食管腺癌患者。比较了最终病理分期和临床分期。评估了人口统计学和临床病理变量作为淋巴结转移的潜在危险因素。使用逻辑回归模型确定与淋巴结受累相关的因素。Kaplan-Meier 分析用于比较有 (N+) 和无 (N-) 淋巴结疾病患者的总生存率和无复发生存率。
我们确定了 80 例单独接受手术治疗的 uT2N0 食管腺癌患者。EUS 临床分期对 73 例患者（91%）不准确。28 例（35%）患者在切除时存在病理 N+疾病。N-患者的 5 年总生存率为 67%，N+患者为 41%（p=0.006）。N-患者的无复发生存率为 65%，N+患者为 32%（p=0.0043）。单变量分析确定血管侵犯和神经侵犯为淋巴结转移的危险因素。多变量分析确定血管侵犯是病理淋巴结受累的独立预测因素。
EUS 对 T2N0 食管腺癌分期不准确，经常无法识别淋巴结受累。应探讨术前活检中血管侵犯的识别作为选择诱导治疗患者的预后标志物。
