Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Ann Thorac Surg. 2024 Jun;117(6):1121-1127. doi: 10.1016/j.athoracsur.2024.01.019. Epub 2024 Feb 1.
Inaccuracy of clinical staging renders management of clinical T2 N0 M0 (cT2 N0 M0) esophageal cancer difficult. When an underlying advanced-stage disease is understaged to cT2 N0 M0, patients miss the opportunity to gain the potential benefits of neoadjuvant therapy. This study aimed to identify preoperative factors that predict underlying advanced-stage esophageal cancer.
From 2000 to 2020, 1579 patients with esophageal cancer underwent esophagectomy. Sixty patients who underwent upfront surgery for cT2 N0 M0 esophageal cancer were included in this study. The median age was 62.5 years, and 78% (n = 47) of these patients were male. Radiologic, clinical, and endoscopic factors were evaluated as preoperative markers. The Fisher exact and the Wilcoxon rank sum tests were used for categoric and continuous variables, respectively. Random forest classification was used to identify preoperative factors for predicting upstaging and downstaging.
Of the 60 patients, 8 (13%) were found to have pathologic T2 N0 M0 esophageal cancer. Sixteen (27%) patients had cancer that was pathologically downstaged, and 36 (60%) had upstaged disease. Seven (19%) patients had upstaged cancer on the basis of the pathologic T stage, 14 (39%) had upstaging on the basis of the pathologic N stage, and 15 (42%) had upstaging on the basis of both T and N stages. Dysphagia (P = .003) and tumor maximum standardized uptake value (P = .048) were predictors of upstaging, with a combined predictive value of up to 75%.
The presence of dysphagia and of high maximum standardized uptake value (≥5) of the tumor is predictive of more advanced underlying disease for patients with cT2 N0 M0 esophageal cancer, and these patients should be considered for neoadjuvant therapy.
临床分期不准确导致临床 T2 N0 M0（cT2 N0 M0）食管癌的治疗变得困难。如果潜在的晚期疾病被误诊为 cT2 N0 M0，患者将错失接受新辅助治疗的潜在获益机会。本研究旨在确定预测 cT2 N0 M0 食管鳞癌潜在晚期疾病的术前因素。
2000 年至 2020 年，共有 1579 例食管癌患者接受了食管癌切除术。本研究纳入了 60 例因 cT2 N0 M0 食管癌而行 upfront 手术的患者。中位年龄为 62.5 岁，78%（n=47）为男性。评估了影像学、临床和内镜因素作为术前标志物。Fisher 确切检验和 Wilcoxon 秩和检验分别用于分类变量和连续变量。随机森林分类用于识别预测分期上调和下调的术前因素。
在 60 例患者中，8 例（13%）病理检查为 T2 N0 M0 食管鳞癌。16 例（27%）患者的癌症病理分期降级，36 例（60%）患者癌症病理分期升级。7 例（19%）患者的 T 分期病理升级，14 例（39%）患者的 N 分期病理升级，15 例（42%）患者的 T 和 N 分期均升级。吞咽困难（P=0.003）和肿瘤最大标准化摄取值（P=0.048）是肿瘤分期上调的预测因素，联合预测值高达 75%。
对于 cT2 N0 M0 食管鳞癌患者，存在吞咽困难和肿瘤最大标准化摄取值较高（≥5）提示潜在疾病更晚期，这些患者应考虑接受新辅助治疗。
