食管鳞癌患者的壁内转移意义：侵袭性癌症行为的指标。
Significance of Intramural Metastasis in Patients with Esophageal Squamous Cell Carcinoma: An Indicator of Aggressive Cancer Behavior.
机构信息
Department of Gastroenterological Surgery, Gastroenterology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
出版信息
World J Surg. 2019 Aug;43(8):1997-2005. doi: 10.1007/s00268-019-05004-z.
BACKGROUND
Intramural metastasis (IM) is occasionally noted in patients with esophageal squamous cell carcinoma (ESCC). However, few recent studies have investigated the clinicopathological characteristics of IM and its survival impact. The present study aimed to clarify the clinicopathological and prognostic significance of IM in patients with ESCC.
METHODS
We retrospectively examined 918 consecutive patients who underwent curative intent esophagectomy for ESCC. IM was defined as a pathologically confirmed metastatic lesion, which was clearly separate from the primary tumor and located within the esophageal or gastric wall. The clinicopathological characteristics and survival impact of IM were evaluated. A propensity score-matched analysis was performed to further elucidate the prognostic impact of IM.
RESULTS
Among 918 patients, 46 (5.0%) had IM. Advanced tumors were significantly more frequent in patients with IM than in those without IM. The curative resection rate was lower in patients with IM (P = 0.001). Overall survival (OS) and disease-specific survival (DSS) were worse in patients with IM (both P < 0.001). In multivariate Cox proportional hazard analysis, IM presence was an independent poor prognostic indicator for OS and DSS (both P < 0.001). After propensity score matching, advanced tumors according to pathological N stage and lymphatic invasion were more frequent in patients with IM (P = 0.015 and 0.004, respectively). Additionally, OS and DSS were different between patients with and those without IM (both P = 0.002).
CONCLUSIONS
IM from ESCC is a local indicator of lymphatic invasion and advanced cancer, as well as an independent factor for poor prognosis.
背景
食管鳞状细胞癌（ESCC）患者偶尔会出现壁内转移（IM）。然而，最近很少有研究调查 IM 的临床病理特征及其对生存的影响。本研究旨在阐明 ESCC 患者 IM 的临床病理和预后意义。
方法
我们回顾性检查了 918 例接受根治性食管切除术治疗 ESCC 的连续患者。IM 定义为经病理证实的转移病变，与原发性肿瘤明显分离，位于食管或胃壁内。评估了 IM 的临床病理特征和生存影响。进行倾向评分匹配分析以进一步阐明 IM 的预后影响。
结果
在 918 例患者中，有 46 例（5.0%）发生了 IM。与无 IM 的患者相比，IM 患者的晚期肿瘤更为常见。IM 患者的根治性切除率较低（P = 0.001）。IM 患者的总生存（OS）和疾病特异性生存（DSS）均较差（均 P < 0.001）。多变量 Cox 比例风险分析显示，IM 的存在是 OS 和 DSS 的独立不良预后因素（均 P < 0.001）。在倾向评分匹配后，IM 患者的病理 N 分期和淋巴管浸润更高级别（分别为 P = 0.015 和 0.004）。此外，IM 患者与无 IM 患者的 OS 和 DSS 存在差异（均 P = 0.002）。
结论
ESCC 的 IM 是淋巴管侵犯和晚期癌症的局部指标，也是预后不良的独立因素。
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