Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Pathology, Gyeongsang National University Hospital, Jinju, South Korea.
J Gastroenterol Hepatol. 2020 Jun;35(6):1009-1015. doi: 10.1111/jgh.14915. Epub 2019 Dec 15.
Knowledge of lymph node metastasis (LNM) status is crucial to determine whether patients with superficial esophageal squamous cell carcinoma (ESCC) can be cured with endoscopic resection alone, without the need for additional esophagectomy. The present study aimed to identify predictive factors and develop a prediction model for LNM in patients with superficial ESCC.
Clinicopathologic data from 501 patients with superficial ESCC treated with radical esophagectomy were reviewed. Stepwise logistic regression analysis determined the predictors of LNM. Using these predictors, a nomogram for predicting the risk of LNM was constructed and internally validated using a bootstrap resampling method.
LNM rates of tumors invading the lamina propria, muscularis mucosa, and SM1 layers were 3.7%, 15.5%, and 40.7%, respectively. Deep tumor invasion depth, moderately or poorly differentiated histology, and lymphovascular invasion were independent predictors of LNM. ESCC with muscularis mucosa and SM1 invasion had odds ratios of 3.635 and 11.834, respectively, compared with that for ESCC confined to the lamina propria. Large tumor size (>2.0 cm) and presence of tumor budding showed borderline significance for LNM prediction. These five variables were incorporated into a nomogram. A constructed nomogram showed good calibration and good discrimination with an area under the receiver-operating characteristic curve (area under the curve [AUC]) of 0.812. After bootstrapping, AUC was 0.811.
We developed a nomogram that can facilitate individualized prediction of risk of LNM in patients with superficial ESCC. This model can aid in decision-making for the need for additional esophagectomy after endoscopic resection for superficial ESCC.
了解淋巴结转移（LNM）状态对于确定是否可以仅通过内镜切除治疗浅表性食管鳞状细胞癌（ESCC）患者，而无需额外进行食管切除术至关重要。本研究旨在确定预测因素，并为浅表性 ESCC 患者的 LNM 建立预测模型。
回顾了 501 例接受根治性食管切除术治疗的浅表性 ESCC 患者的临床病理资料。逐步逻辑回归分析确定了 LNM 的预测因素。使用这些预测因素，构建了用于预测 LNM 风险的列线图，并使用自举重采样方法进行内部验证。
侵犯黏膜固有层、黏膜肌层和 SM1 层的肿瘤的 LNM 率分别为 3.7%、15.5%和 40.7%。肿瘤深度的深层侵犯、中或低分化组织学和淋巴管血管侵犯是 LNM 的独立预测因素。与局限于黏膜固有层的 ESCC 相比，侵犯黏膜肌层和 SM1 层的 ESCC 的优势比分别为 3.635 和 11.834。大肿瘤大小（>2.0cm）和肿瘤芽出现对 LNM 预测具有边缘意义。这五个变量被纳入列线图。构建的列线图显示出良好的校准和良好的区分度，接受者操作特征曲线下的面积（AUC）为 0.812。自举后，AUC 为 0.811。
我们开发了一种列线图，可以方便地预测浅表性 ESCC 患者的 LNM 风险。该模型可以帮助决策是否需要在浅表性 ESCC 内镜切除后进行额外的食管切除术。
