Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.
Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
Ann Surg Oncol. 2019 Jun;26(6):1909-1915. doi: 10.1245/s10434-019-07308-9. Epub 2019 Mar 19.
The tumor, node, metastasis classification system for staging esophageal cancer does not include tumor volume although it may be an important prognostic factor. We evaluated the prognostic value of tumor volume in esophageal cancer.
We performed a retrospective study in patients with histologically confirmed primary esophageal cancer who underwent curative esophagectomy at our facility between April 1992 and December 2013. The Tumor Depth Parameter (TDP) was defined as mucosa = 1, submucosa = 2, muscularis propria = 3, adventitia = 4, and invasion into adjacent organs = 5. The pathological Tumor Volume Index (TVI) was defined as the major axis × the minor axis × TDP. The appropriate tumor diameter and TVI cutoff values were determined by the Youden index obtained from the receiver operating characteristic curve. Prognostic factors for overall survival were evaluated by univariate analysis and Cox proportional hazards regression models.
We enrolled 302 patients. In the univariate analysis, patient age and sex, thoracoscopic surgery, tumor depth of invasion and diameter, lymph node metastasis, and the TVI were significantly associated with overall survival. In our multivariate analysis, patient age and sex, thoracoscopic surgery, lymph node metastasis, and the TVI were independently associated with overall survival.
The pathological TVI was an independent prognostic factor in patients with esophageal carcinoma and could be included in the staging system of esophageal cancer.
尽管肿瘤体积可能是一个重要的预后因素，但用于食管癌分期的肿瘤、淋巴结、转移分类系统并不包括肿瘤体积。我们评估了肿瘤体积在食管癌中的预后价值。
我们对在我们医院接受根治性食管切除术的经组织学证实的原发性食管癌患者进行了回顾性研究，这些患者于 1992 年 4 月至 2013 年 12 月在我院接受治疗。肿瘤深度参数（TDP）定义为黏膜=1、黏膜下层=2、固有肌层=3、外膜=4、侵犯相邻器官=5。病理肿瘤体积指数（TVI）定义为长轴×短轴×TDP。通过来自接收者操作特征曲线的约登指数确定合适的肿瘤直径和 TVI 截断值。使用单因素分析和 Cox 比例风险回归模型评估总生存率的预后因素。
我们纳入了 302 名患者。在单因素分析中，患者年龄和性别、胸腔镜手术、肿瘤浸润深度和直径、淋巴结转移以及 TVI 与总生存率显著相关。在我们的多因素分析中，患者年龄和性别、胸腔镜手术、淋巴结转移和 TVI 与总生存率独立相关。
病理 TVI 是食管癌患者的独立预后因素，可纳入食管癌分期系统。
