Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Thorac Cardiovasc Surg. 2019 Jan;157(1):397-402.e1. doi: 10.1016/j.jtcvs.2018.07.034. Epub 2018 Jul 29.
The aims of this study were to identify risk factors for lymph node metastasis and develop a reliable risk stratification system.
Between May 2001 and December 2015, 262 patients who underwent endoscopic resection or surgery for superficial esophageal squamous cell carcinoma were enrolled. We evaluated possible predictive factors for lymph node metastasis: age, gender, tumor length, tumor area, circumferential spread, tumor location, gross appearance, depth of invasion, tumor differentiation, and lymphovascular invasion.
The incidence of lymph node metastasis was 14.5% (38/262). In multivariate analysis, tumor size (>15 mm), depth of invasion (submucosal invasion), and lymphovascular invasion were significantly associated with lymph node metastasis. These factors were included in the risk stratification system and assigned scores; the total risk stratification system score was 0 to 6. The area under the receiver operating characteristic curve for predicting lymph node metastasis was 0.869 (95% confidence interval, 0.813-0.926). The high-risk group (risk stratification system score ≥3) exhibited a significantly higher risk of lymph node metastasis than the low-risk group (score <3) (26.5% vs 1.6%). There was no lymph node metastasis in patients with a risk stratification system of 0. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the risk stratification system were 94.7%, 55.4%, 26.5%, 98.4%, and 61.1%, respectively.
We developed a risk stratification system that should facilitate the identification of patients with a high or low risk of lymph node metastasis. This may aid the precise selection of patients who can undergo endoscopic resection.
本研究旨在确定淋巴结转移的危险因素，并建立一个可靠的风险分层系统。
2001 年 5 月至 2015 年 12 月，我们共纳入 262 例行内镜切除或手术治疗的浅表性食管鳞癌患者。我们评估了可能预测淋巴结转移的因素：年龄、性别、肿瘤长度、肿瘤面积、环周扩散、肿瘤位置、大体形态、浸润深度、肿瘤分化程度和淋巴管血管侵犯。
淋巴结转移发生率为 14.5%（38/262）。多因素分析显示，肿瘤大小（>15mm）、浸润深度（黏膜下浸润）和淋巴管血管侵犯与淋巴结转移显著相关。这些因素被纳入风险分层系统并赋予评分；总风险分层系统评分为 0-6 分。预测淋巴结转移的受试者工作特征曲线下面积为 0.869（95%置信区间，0.813-0.926）。高风险组（风险分层系统评分≥3）的淋巴结转移风险明显高于低风险组（评分<3）（26.5% vs 1.6%）。风险分层系统为 0 的患者无一例发生淋巴结转移。风险分层系统的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为 94.7%、55.4%、26.5%、98.4%和 61.1%。
我们建立了一个风险分层系统，有助于识别淋巴结转移高风险或低风险的患者。这可能有助于准确选择可接受内镜切除的患者。
