Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Surg Oncol. 2021 Mar;123(4):891-903. doi: 10.1002/jso.26376. Epub 2021 Jan 12.
To explore the prognostic significance of tumor deposits (TDs), isolated tumor foci lacking residual lymph nodes, in esophageal cancer (EC).
A retrospective review of patients with EC undergoing esophagectomy between 2005 and 2017 was conducted. The prognostic value of TD was evaluated using a Cox regression model. Patients from different sources and periods were split into discovery and validation sets. A propensity score matching model was used in the validation set to reduce the confounding bias. The impact of TD on the TNM classification system was evaluated.
The discovery and validation sets included 179 and 2875 patients, respectively. Propensity-matched patients with and without TDs were constructed in the validation set with 132 patients in each group. Overall survival (p < .001 and p = .004, respectively) and disease-free survival (p < .001 and p = .019, respectively) were both decreased in TD positive patients in the discovery set and propensity-matched groups of validation set. Classifying patients with TDs into pN3 stage improved the discriminative power of the current TNM staging system.
TD is an independent prognostic factor for EC. The inclusion of TD in the TNM staging system may upstage appropriate patients to help guide therapy, and future studies are warranted.
探讨肿瘤沉积物（TDs）在食管癌（EC）中的预后意义，肿瘤沉积物是指缺乏残留淋巴结的孤立肿瘤灶。
回顾性分析了 2005 年至 2017 年间接受食管切除术的 EC 患者。采用 Cox 回归模型评估 TD 的预后价值。将来自不同来源和不同时期的患者分为发现集和验证集。在验证集中使用倾向评分匹配模型来减少混杂偏倚。评估 TD 对 TNM 分类系统的影响。
发现集和验证集分别纳入了 179 例和 2875 例患者。在验证集中，为每组构建了有和无 TDs 的倾向评分匹配患者，每组各 132 例。在发现集中，TD 阳性患者的总生存（p<0.001 和 p=0.004）和无病生存（p<0.001 和 p=0.019）均降低；在倾向评分匹配的验证集中，TD 阳性患者的总生存和无病生存也均降低。将 TD 患者分为 pN3 期可提高当前 TNM 分期系统的判别能力。
TD 是 EC 的独立预后因素。将 TD 纳入 TNM 分期系统可能会使适当的患者分期升高，有助于指导治疗，未来需要进一步研究。
