Department of Paediatric Surgery, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Germany.
Department of Surgery I, Sana Klinikum Offenbach, Offenbach, Germany.
World J Surg. 2020 Apr;44(4):1192-1199. doi: 10.1007/s00268-019-05291-6.
Research in early esophageal adenocarcinoma focused on prediction of lymph node metastases in order to stratify patients for endoscopic treatment instead of esophagectomy. Although distant metastases were described in rates of up to 13% of patients within a follow-up of 3 years, their prediction has been neglected so far.
In a secondary analysis, a cohort of 217 patients (53 T1a and 164 T1b) treated by esophagectomy was analyzed for histopathological risk factors. Their ability to predict the combination of lymph node metastases at surgery as well as metachronous locoregional and distant metastases (overall metastatic rate) was assessed by uni- and multivariate logistic regression analysis.
Tumor invasion depth was correlated with both lymph node metastases at surgery (τ = 0.141; P = .012), tumor recurrences (τ = 0.152; P = .014), and distant metastases (τ = 0.122; P = 0.04). Multivariate analysis showed an odds ratio of 1.31 (95% CI 1.02-1.67; P = .033) per increasing tumor invasion depth and of 3.5 (95% CI 1.70-6.56; P < .001) for lymphovascular invasion. The pre-planned subgroup analysis in T1b tumors demonstrated an even lower predictive ability of lymphovascular invasion with an odds ratio of 2.5 (95% CI 1.11-5.65; P = 0.028), whereas the predictive effect of sm2 (odds ratio 3.44; 95% CI 1.00-11.9; P = 0.049) and sm3 (odds ratio 3.44; 95% CI 1.00-11.9; P = 0.049) tumor invasion depth was similar.
The present report demonstrates the insufficient risk prediction of histopathologic risk factors for the overall metastatic rate.
早期食管腺癌的研究侧重于预测淋巴结转移，以便对内镜治疗而不是食管切除术进行分层。尽管在 3 年的随访中，多达 13%的患者出现了远处转移，但迄今为止，对其预测一直被忽视。
在一项二次分析中，对接受食管切除术治疗的 217 例患者（53 例 T1a 和 164 例 T1b）的组织病理学危险因素进行了分析。通过单变量和多变量逻辑回归分析评估了这些因素预测手术时淋巴结转移以及同时发生的局部区域和远处转移（总转移率）的能力。
肿瘤浸润深度与手术时的淋巴结转移（τ=0.141；P=0.012）、肿瘤复发（τ=0.152；P=0.014）和远处转移（τ=0.122；P=0.04）相关。多变量分析显示，肿瘤浸润深度每增加 1 个单位，优势比为 1.31（95%可信区间 1.02-1.67；P=0.033），而淋巴管侵犯的优势比为 3.5（95%可信区间 1.70-6.56；P<0.001）。在 T1b 肿瘤的预计划亚组分析中，淋巴管侵犯的预测能力更低，优势比为 2.5（95%可信区间 1.11-5.65；P=0.028），而 sm2（优势比 3.44；95%可信区间 1.00-11.9；P=0.049）和 sm3（优势比 3.44；95%可信区间 1.00-11.9；P=0.049）肿瘤浸润深度的预测作用相似。
本报告表明，组织病理学危险因素对总转移率的风险预测不足。
