Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Thorac Cardiovasc Surg. 2022 Jul;164(1):265-275.e5. doi: 10.1016/j.jtcvs.2021.10.033. Epub 2021 Oct 28.
To investigate long-term survival outcomes and develop a risk model for occult lymph node metastasis (LNM) in patients with clinical T1 through T2 N0 esophageal squamous cell carcinoma.
From 2006 to 2018, 675 patients with clinical T1 through T2 N0 esophageal cancer who underwent upfront surgery were analyzed. The survival of patients with occult LNM was compared with that of 116 patients with clinical T1 through T2N+ cancer who underwent neoadjuvant therapy plus surgery. After randomly dividing the patients with clinical T1 through T2 N0 tumors into the training and testing sets, a risk model for occult LNM was developed and validated.
Among patients with clinical T1 through T2 N0 esophageal cancer, occult LNM was found in 147 (21.8%) but not in 528 (78.2%). Patients with occult LNM had significantly worse prognosis than those without (P < .001), but showed similar outcomes to patients with clinical T1 through T2 N+ cancer (P = .981). According to the risk model, tumor maximum standardized uptake >3.8 (P = .002), histological differentiation grade (P = .015), tumor length >25 mm (P < .001), and advanced clinical T stage (P < .001) were independent risk factors for occult LNM in clinical T1 through T2 N0 cancer. A risk scoring system based on this model showed high accuracy (0.81) and good discriminant ability in both training sets (area under the receiver operating characteristic curve, 0.759 and testing area under the receiver operating characteristic curve, 0.743).
Our risk scoring system for predicting occult LNM in clinical T1 through T2 N0 esophageal cancer has high accuracy and good discriminant ability.
探讨临床 T1-T2N0 期食管鳞状细胞癌隐匿性淋巴结转移（LNM）的长期生存结果，并建立隐匿性 LNM 的风险模型。
回顾性分析 2006 年至 2018 年间 675 例接受根治性手术的临床 T1-T2N0 食管癌患者。比较隐匿性 LNM 患者与 116 例接受新辅助治疗加手术的临床 T1-T2N+癌症患者的生存情况。将临床 T1-T2N0 肿瘤患者随机分为训练集和测试集，建立并验证隐匿性 LNM 的风险模型。
在临床 T1-T2N0 食管癌患者中，147 例（21.8%）患者存在隐匿性 LNM，而 528 例（78.2%）患者不存在。隐匿性 LNM 患者的预后明显差于无隐匿性 LNM 患者（P<0.001），但与临床 T1-T2N+癌症患者的结局相似（P=0.981）。根据风险模型，肿瘤最大标准化摄取值>3.8（P=0.002）、组织学分化程度（P=0.015）、肿瘤长度>25mm（P<0.001）和较晚期的临床 T 分期（P<0.001）是临床 T1-T2N0 癌症中隐匿性 LNM 的独立危险因素。基于该模型的风险评分系统在训练集（接受者操作特征曲线下面积分别为 0.759 和 0.743）和测试集（接受者操作特征曲线下面积分别为 0.81）中均具有较高的准确性和良好的判别能力。
本研究建立的预测临床 T1-T2N0 期食管鳞癌隐匿性 LNM 的风险评分系统具有较高的准确性和良好的判别能力。
