Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
Ann Surg Oncol. 2020 Oct;27(10):3762-3769. doi: 10.1245/s10434-020-08474-x. Epub 2020 Apr 23.
Peri- or intra-tumor lymphangiogenesis is induced in several types of cancer. However, the significance of peritumoral lymphatic vessels (LVs) in esophageal cancer (EC) remains to be clarified.
This study included 162 eligible EC patients with or without neoadjuvant chemotherapy (NAC). The numbers of non-tumoral and peritumoral LVs were counted in resected specimens based on podoplanin immunostaining. The association between peritumoral LV number and clinicopathologic parameters, including tumor heterogeneity as measured by positron emission tomography, NAC response, and patient survival were analyzed.
In non-NAC patients, the number of peritumoral LVs was highest in the lamina propria mucosa (LPM), followed by non-tumoral LVs in the LPM, peritumoral LVs in the submucosa (SM), and non-tumoral LVs in the SM. The patients with a low number of peritumoral LVs in the LPM versus those with a high number constituted a larger fraction of the NAC patients (67.8% vs. 50.0%; P = 0.022) and had a poorer pathologic response to NAC (grades 0-1a: 68.8% vs. 47.2%; P = 0.035), as well as greater tumor heterogeneity and worse survival (5-year overall survival: 50.6% vs. 72.8%; P = 0.0097). The number of peritumoral LVs in the LPM was identified as an independent prognostic factor with the highest hazard ratio (HR) of overall survival (HR 2.06; P = 0.0049) in the multivariate analysis.
For EC patients, peritumoral LVs in the LPM layer are associated with tumor heterogeneity, response to NAC, and unfavorable survival.
几种类型的癌症都会诱导肿瘤周围或肿瘤内淋巴管生成。然而，肿瘤周围淋巴管（LV）在食管癌（EC）中的意义仍有待阐明。
本研究纳入了 162 名符合条件的 EC 患者，包括接受或未接受新辅助化疗（NAC）的患者。根据 podoplanin 免疫染色，在切除标本中计数非肿瘤和肿瘤周围 LV 的数量。分析了肿瘤周围 LV 数量与临床病理参数之间的关系，包括正电子发射断层扫描（PET）测量的肿瘤异质性、NAC 反应和患者生存。
在未接受 NAC 的患者中，肿瘤周围 LV 数量在固有层黏膜（LPM）最高，其次是非肿瘤周围 LPM 中的 LV、黏膜下（SM）的肿瘤周围 LV 和 SM 中的非肿瘤周围 LV。肿瘤周围 LPM 中 LV 数量较少的患者构成 NAC 患者的比例更大（67.8%比 50.0%；P=0.022），对 NAC 的病理反应更差（0-1a 级：68.8%比 47.2%；P=0.035），肿瘤异质性更大，生存更差（5 年总生存率：50.6%比 72.8%；P=0.0097）。肿瘤周围 LPM 中 LV 的数量被确定为独立的预后因素，在多变量分析中总生存率的风险比（HR）最高（HR 2.06；P=0.0049）。
对于 EC 患者，LPM 层的肿瘤周围 LV 与肿瘤异质性、NAC 反应和不良生存相关。
