Li Meng, Xie Hounai, Zhen Feng, Wang Hui, Peng Zhongmin, Xu Lin
Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, P. R. China.
J Cancer Res Ther. 2020 Sep;16(5):1106-1111. doi: 10.4103/jcrt.JCRT_1171_19.
Even with the use of contrast-enhanced thin-layer chest computed tomography (CT) and endoscopic ultrasonography (EUS), the likelihood of cT2N0M0 squamous cell esophageal cancer correlating with the final pathologic outcome is exceedingly low. We therefore sought to investigate the associations between different risk factors and pathologic upstaging in stage T2N0M0 esophageal cancer patients who underwent esophagectomy.
We retrospectively reviewed the clinicopathological characteristics of 224 stage T2N0M0 squamous cell esophageal cancer patients who underwent complete resection over a 2-year period (October 2016-September 2018). The tumor volume (TV) was automatically measured from thin-layer chest CT scans using imaging software. Univariate and multivariate analyses were performed to identify the risk factors associated with upstaging. A receiver operating characteristic (ROC) curve was plotted, and its ability to identify pathological upstaging was assessed.
A total of 224 patients with clinical stage T2N0M0 squamous cell esophageal carcinoma (SCEC) underwent esophagectomy; of these patients, 96 (42.86%) had a more advanced stage during the final pathologic review than during the initial diagnosis. The risk factors for pathologic upstaging included a large TV, high total cholesterol (TC), high triglycerides (TGs), high platelet-to-lymphocyte ratio (PLR), and high number of lymph nodes examined. The ROC analysis demonstrated an area under the curve of 0.845 (95% confidence interval 0.794-0.895).
In SECC diagnosed as stage T2N0M0 by CT and EUS, the incidence of postoperative pathologic upstaging increases with a large TV, high TC, high TGs, high PLR, and high number of lymph nodes examined.
即使使用对比增强薄层胸部计算机断层扫描（CT）和内镜超声检查（EUS），cT2N0M0期食管鳞状细胞癌与最终病理结果相符的可能性也极低。因此，我们试图研究接受食管切除术的T2N0M0期食管癌患者不同风险因素与病理分期上调之间的关联。
我们回顾性分析了224例在2年期间（2016年10月至2018年9月）接受完全切除的T2N0M0期食管鳞状细胞癌患者的临床病理特征。使用成像软件从薄层胸部CT扫描中自动测量肿瘤体积（TV）。进行单因素和多因素分析以确定与分期上调相关的风险因素。绘制了受试者工作特征（ROC）曲线，并评估其识别病理分期上调的能力。
共有224例临床分期为T2N0M0的食管鳞状细胞癌（SCEC）患者接受了食管切除术；在这些患者中，96例（42.86%）在最终病理检查时的分期比初始诊断时更晚。病理分期上调的风险因素包括TV大、总胆固醇（TC）高、甘油三酯（TGs）高、血小板与淋巴细胞比值（PLR）高以及检查的淋巴结数量多。ROC分析显示曲线下面积为0.845（95%置信区间0.794 - 0.895）。
在CT和EUS诊断为T2N0M0期的SECC中，术后病理分期上调的发生率随着TV大、TC高、TGs高、PLR高以及检查的淋巴结数量多而增加。
