Lin Dong, Liu Guobing, Jiang Dongxian, Yu Yangli, Wang Hao, Shi Hongcheng, Tan Lijie
Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.
Department of Nuclear Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
Ann Transl Med. 2021 Jan;9(2):112. doi: 10.21037/atm-20-4430.
The controversy regarding optimal clinical T2N0 esophageal cancer treatment ultimately stems from the clinical staging modalities' inaccuracy. Because most inaccuracies lie in clinical T2 to pathological T1, it is vital to discriminate whether the muscularis propria is invaded.
We investigated the association between the primary tumor maximal standard uptake value (SUVmax), and the pathological features and overall survival. We attempted to construct a discriminative model through logistic regression analysis.
A total of 140 cN0 esophageal squamous cell carcinoma (ESCC) patients were enrolled. Primary tumor SUVmax differed significantly in paired pathological T categories (P<0.05), but not pT2 . pT3 (P=0.648). Age (≤65 . >65), biopsy differentiation grades (well or moderately . poorly . unknown), and primary tumor SUVmax (continuous) were independent risk factors for invasion depth. Subsequently, the age categories, the biopsy differentiation grade categories, and the primary tumor SUVmax categories (≤7.4 . >7.4) were included in the logistic regression analysis to construct a discriminative model, showing a good performance in discriminating pT2-3 . pT1 in terms of accuracy 87.1%, sensitivity 93.6%, specificity 73.9%, and area under the curve (AUC) 0.887 [95% confidence interval (CI): 0.822 to 0.951]. Of these factors, biopsy differentiation grades and primary tumor SUVmax showed significant differences in overall survival (P<0.05), while the age categories did not.
The novel baseline model comprised of age, biopsy differentiation grades, and primary tumor SUVmax provide much discriminative performance in determining whether the muscularis propria is invaded. Further studies are necessary to validate the findings and guide clinical practice for cT2N0 esophageal cancer.
关于临床T2N0期食管癌最佳治疗方案的争议最终源于临床分期方式的不准确。由于大多数不准确之处在于临床T2期与病理T1期的差异，因此区分固有肌层是否受侵至关重要。
我们研究了原发肿瘤最大标准摄取值（SUVmax）与病理特征及总生存期之间的关联。我们试图通过逻辑回归分析构建一个判别模型。
共纳入140例cN0期食管鳞状细胞癌（ESCC）患者。原发肿瘤SUVmax在配对的病理T类别中差异显著（P<0.05），但在pT2和pT3之间差异不显著（P=0.648）。年龄（≤65岁、>65岁）、活检分化程度（高分化或中分化、低分化、未知）和原发肿瘤SUVmax（连续变量）是浸润深度的独立危险因素。随后，将年龄类别、活检分化程度类别和原发肿瘤SUVmax类别（≤7.4、>7.4）纳入逻辑回归分析以构建判别模型，该模型在区分pT2-3和pT1方面表现良好，准确率为87.1%，敏感性为93.6%，特异性为73.9%，曲线下面积（AUC）为0.887 [95%置信区间（CI）：0.822至0.951]。在这些因素中，活检分化程度和原发肿瘤SUVmax在总生存期方面存在显著差异（P<0.05），而年龄类别则无差异。
由年龄、活检分化程度和原发肿瘤SUVmax组成的新型基线模型在确定固有肌层是否受侵方面具有良好的判别性能。需要进一步研究以验证这些发现并指导cT2N0期食管癌的临床实践。
