Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China.
Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China.
J Cardiothorac Surg. 2023 Apr 7;18(1):111. doi: 10.1186/s13019-023-02272-8.
Venous invasion (VI) is an adverse prognostic indicator in esophageal squamous cell carcinoma. However, grading criteria for venous invasion in thoracic esophageal squamous cell carcinoma (ESCC) have not been established.
We enrolled 598 thoracic ESCC patients from 2005 to 2017. We detected the presence of venous invasion using the hematoxylin and eosin (H&E)-staining method and evaluated the VI grade on the basis of the number and maximal size of the involved veins. The degree of VI was classified as either 0, V1, V2, or V3, according to the combination of V-number and V-size.
The 1-year, 3-year and 5-year disease-free survival rates were 79.7%, 64.7% and 61.2%, respectively. Multivariate analysis demonstrated that lymphatic invasion (HR: 1.457, 95% CI: 1.058-2.006, p = 0.021), T category (HR: 1.457, 95% CI: 1.058-2.006, p = 0.022), N category (HR: 1.535, 95% CI: 1.276-2.846, p < 0.001), stage (HR: 1.563, 95% CI: 1.235-1.976, p < 0.001) and the degree of venous invasion (HR: 1.526, 95% CI: 1.279-2.822, p < 0.001) were significant indicators of recurrence. The disease-free survival curves were distinguished especially well by the degree of venous invasion in stage III and IV patients.
The present study explored an objective grading criterion for VI and proved the prognostic value of the degree of venous invasion in ESCC. The classification of venous invasion into 4 groups is useful for the differentiation of prognosis in ESCC patients. The prognostic significance of the degree of VI in advanced ESCC patients for recurrence may have to be considered.
静脉侵犯（VI）是食管鳞状细胞癌的不良预后指标。然而，胸段食管鳞状细胞癌（ESCC）的静脉侵犯分级标准尚未建立。
我们纳入了 2005 年至 2017 年间的 598 例胸段 ESCC 患者。我们使用苏木精和伊红（H&E）染色法检测静脉侵犯的存在，并根据受累静脉的数量和最大直径评估 VI 分级。根据 V 数和 V 大小的组合，将 VI 程度分为 0、V1、V2 或 V3。
1 年、3 年和 5 年无病生存率分别为 79.7%、64.7%和 61.2%。多因素分析表明，淋巴血管侵犯（HR：1.457，95%CI：1.058-2.006，p=0.021）、T 分期（HR：1.457，95%CI：1.058-2.006，p=0.022）、N 分期（HR：1.535，95%CI：1.276-2.846，p<0.001）、分期（HR：1.563，95%CI：1.235-1.976，p<0.001）和静脉侵犯程度（HR：1.526，95%CI：1.279-2.822，p<0.001）是复发的显著指标。静脉侵犯程度在 III 期和 IV 期患者的无病生存曲线中区分得尤为明显。
本研究探讨了一种 VI 的客观分级标准，并证明了 ESCC 中静脉侵犯程度的预后价值。将静脉侵犯分为 4 组有助于区分 ESCC 患者的预后。晚期 ESCC 患者静脉侵犯程度对复发的预后意义可能需要考虑。
