Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital.
Fujian Key Laboratory of Translational Cancer Medicine.
Eur J Cancer Prev. 2024 Mar 1;33(2):152-160. doi: 10.1097/CEJ.0000000000000847. Epub 2023 Nov 6.
There is still a lack of high-level clinical evidence and uniform conclusions on whether there are differences in lymph node metastasis (LNM) and prognosis between early esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC).
Patients with surgically resected, histologically diagnosed, pT1 EAC or ESCC in the Surveillance, Epidemiology and End Results registries database from 2004 to 2015 were included. Multivariable logistic regression, Cox regression, multivariate competing risk model, and propensity score matching were used to analyze association the histology and LNM or prognosis.
A total of 570 early esophageal cancer patients were included. The LNM rates were 13.8% and 15.1% for EAC and ESCC ( P = 0.757), respectively. Multivariate logistic regression analysis showed no significant association between histological type and LNM (odds ratio [OR], 1.209; 95% CI, 0.538-2.715; P = 0.646). Moreover, the prognosis of early EAC and ESCC was shown to be comparable in both multivariate Cox regression (hazard ratio [HR], 1.483; 95% CI, 0.699-3.150; P = 0.305) and the multivariate competing risk model (subdistribution HR, 1.451; 95% CI, 0.628-3.354; P = 0.383). After propensity score matching, there were no significant differences between early EAC and ESCC in terms of LNM (10.6% vs.18.2%, P = 0.215), 5-year CSS (89.8% [95% CI, 81.0%-98.6%] vs. 79.1% [95% CI, 67.9%-90.3%], P = 0.102) and 5-year cumulative incidence of CSS (10.2% [95% CI, 1.4%-19.0%] vs. 79.1% [95% CI, 9.7%-32.1%], P = 0.124).
The risk of LNM and prognosis of early ESCC and EAC are comparable, so the treatment choice for early esophageal cancer does not depend on the histologic type.
早期食管腺癌（EAC）与鳞癌（ESCC）的淋巴结转移（LNM）和预后是否存在差异，目前仍缺乏高级别的临床证据和统一的结论。
本研究纳入了 2004 年至 2015 年监测、流行病学和最终结果（SEER）数据库中接受手术切除、组织学诊断为 pT1 EAC 或 ESCC 的患者。采用多变量逻辑回归、Cox 回归、多变量竞争风险模型和倾向评分匹配分析组织学与 LNM 或预后的关系。
共纳入 570 例早期食管癌患者。EAC 和 ESCC 的 LNM 率分别为 13.8%和 15.1%（P=0.757）。多变量逻辑回归分析显示，组织学类型与 LNM 无显著相关性（比值比[OR]，1.209；95%置信区间[CI]，0.538-2.715；P=0.646）。此外，多变量 Cox 回归（风险比[HR]，1.483；95%CI，0.699-3.150；P=0.305）和多变量竞争风险模型（亚分布 HR，1.451；95%CI，0.628-3.354；P=0.383）均显示早期 EAC 和 ESCC 的预后相当。在倾向评分匹配后，EAC 和 ESCC 的 LNM（10.6% vs.18.2%，P=0.215）、5 年 CSS（89.8%[95%CI，81.0%-98.6%] vs.79.1%[95%CI，67.9%-90.3%]，P=0.102）和 5 年 CSS 累积发生率（10.2%[95%CI，1.4%-19.0%] vs.79.1%[95%CI，9.7%-32.1%]，P=0.124）均无显著差异。
早期 ESCC 和 EAC 的 LNM 风险和预后相当，因此早期食管癌的治疗选择不依赖于组织学类型。
