Department of Cardiothoracic Surgery, Mayo Clinic, Phoenix, AZ, USA.
Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Ann Surg Oncol. 2024 Oct;31(10):6680-6690. doi: 10.1245/s10434-024-15717-8. Epub 2024 Jul 17.
The significance of lymphovascular invasion (LVI) in esophageal adenocarcinoma (EAC) has not yet been described. Potential utility as an adjunct to current staging guidelines remains unknown.
The National Cancer Database was queried from 2006 to 2020. Univariate and multivariable models, Kaplan Meier method, and log-rank test were used. Subgroup analyses by pN stage were conducted.
Of 9,689 patients, 23.2% had LVI. LVI was an independent prognostic factor (hazard ratio [HR] 1.401, 95% confidence interval [CI] 1.307-1.502, p < 0.0001) with reduction in median survival to 20.0 months (95% CI 18.9-21.4) from 39.7 months (95% CI 37.8-42.3, p < 0.0001). Multivariable survival analysis adjusted on pN and pT stage found that patients with LVI had decreased survival in a given pN stage (p < 0.001). pN0/LVI+ patients had a similar prognosis to the higher staged pN1/LVI- (28.6 months), although pN1/LVI- patients did slightly worse (p = 0.0135). Additionally, patients with pN1/LVI+ had equivalent survival compared with pN2/LVI- (p = 0.178) as did pN2/LVI+ patients compared with pN3/LVI- (p = 0.995).
In these data, LVI is an independent negative prognostic factor in EAC. LVI was associated with a survival reduction similar to an upstaged nodal status irrespective of T stage. Patients with LVI may be better classified at a higher pN stage.
淋巴血管侵犯（LVI）在食管腺癌（EAC）中的意义尚未描述。其作为当前分期指南辅助手段的潜在效用尚不清楚。
从 2006 年到 2020 年，国家癌症数据库被查询。使用单变量和多变量模型、Kaplan-Meier 方法和对数秩检验。进行了按 pN 分期的亚组分析。
在 9689 名患者中，23.2%有 LVI。LVI 是一个独立的预后因素（风险比[HR]1.401，95%置信区间[CI]1.307-1.502，p<0.0001），中位生存时间从 39.7 个月（95%CI 37.8-42.3）缩短至 20.0 个月（95%CI 18.9-21.4，p<0.0001）。多变量生存分析调整了 pN 和 pT 分期，发现 LVI 患者在给定的 pN 分期中生存率降低（p<0.001）。pN0/LVI+患者的预后与更高分期的 pN1/LVI-（28.6 个月）相似，尽管 pN1/LVI-患者略差（p=0.0135）。此外，pN1/LVI+患者的生存与 pN2/LVI-（p=0.178）相当，pN2/LVI+患者与 pN3/LVI-（p=0.995）相当。
在这些数据中，LVI 是 EAC 的一个独立的负预后因素。LVI 与生存减少相关，与 T 分期无关，类似于分期较高的淋巴结状态。有 LVI 的患者可能在更高的 pN 分期中得到更好的分类。
