Predicting Lymph Node Metastases in Early Esophageal Adenocarcinoma Using a Simple Scoring System

被引:79
作者
Lee, Lawrence [1 ]
Ronellenfitsch, Ulrich [2 ]
Hofstetter, Wayne L. [4 ]
Darling, Gail [5 ]
Gaiser, Timo [3 ]
Lippert, Christiane [3 ]
Gilbert, Sebastien [6 ]
Seely, Andrew J. [6 ]
Mulder, David S. [1 ]
Ferri, Lorenzo E. [1 ]
机构
[1] McGill Univ, Ctr Hlth, Montreal, PQ H3G 1A4, Canada
[2] Univ Med Ctr Mannheim, Dept Surg, Mannheim, Germany
[3] Univ Med Ctr Mannheim, Inst Pathol, Mannheim, Germany
[4] MD Anderson Canc Ctr, Dept Thorac & Cardiovasc Surg, Houston, TX USA
[5] Univ Hlth Network, Div Thorac Surg, Toronto, ON, Canada
[6] Ottawa Hosp, Div Thorac Surg, Ottawa, ON, Canada
关键词
HIGH-GRADE DYSPLASIA; ENDOSCOPIC MUCOSAL RESECTION; OPERATIVE MORTALITY; CARCINOMA; CANCER; IMPUTATION; OUTCOMES; VALUES; EMR;
D O I
10.1016/j.jamcollsurg.2013.03.015
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Endoscopic resection is an organ-sparing option for early esophageal adenocarcinoma, but should be used only in patients with a negligible risk of lymph node metastases (LNM). The objective was to develop a simple scoring system to predict LNM in T1 esophageal adenocarcinoma. STUDY DESIGN: All primary esophagectomies performed for T1 esophageal adenocarcinoma without neoadjuvant therapy at 5 university institutions from 2000 to 2011 were analyzed. Patient and pathologic characteristics were compared between patients with LNM at the time of surgical resection and those without. Univariate and multivariate analyses were performed to establish a simple scoring system that estimated the risk of LNM, using variables from the final surgical pathology. RESULTS: A total of 258 patients were included for analysis (mean age 65.2 years [SD 10.3 years], 88% male). The incidence of LNM was 7% (9 of 122) for T1a and 26% (35 of 136) for T1b. Tumor size (odds ratio [OR] 1.35 per cm, 95% CI 1.07 to 1.71) and lymphovascular invasion (OR 7.50, 95% CI 3.30 to 17.07) were the strongest independent predictors of LNM. A weighted scoring system was devised from the final multivariate model and included size (+1 point per cm), depth of invasion (+2 for T1b), differentiation (+3 for each step of dedifferentiation), and lymphovascular invasion (+6 if present). Total number of points estimated the probability of LNM (low risk [0 to 1 point], <= 2%; moderate risk [2 to 4 points], 3% to 6%; and high risk [5+ points], >= 7%). CONCLUSIONS: We devised a simple scoring system that accurately estimates the risk of LNM to aid in decision-making in patients with T1 esophageal adenocarcinoma undergoing endoscopic resection. (C) 2013 by the American College of Surgeons
引用
收藏
页码:191 / 199
页数:9
相关论文
共 36 条
[1]   Multifocal neoplasia and nodal metastases in T1 esophageal carcinoma - Implications for endoscopic treatment [J].
Altorki, Nasser K. ;
Lee, Paul C. ;
Liss, Yaakov ;
Meherally, Danish ;
Korst, Robert J. ;
Christos, Paul ;
Mazumdar, Madhu ;
Port, Jeffrey L. .
ANNALS OF SURGERY, 2008, 247 (03) :434-439
[2]   Prediction of Lymph Node Status in Superficial Esophageal Carcinoma [J].
Ancona, Ermanno ;
Rampado, Sabrina ;
Cassaro, Mauro ;
Battaglia, Giorgio ;
Ruol, Alberto ;
Castoro, Carlo ;
Portale, Giuseppe ;
Cavallin, Francesco ;
Rugge, Massimo .
ANNALS OF SURGICAL ONCOLOGY, 2008, 15 (11) :3278-3288
[3]   Reducing hospital morbidity and mortality following esophagectomy [J].
Atkins, BZ ;
Shah, AS ;
Hutcheson, KA ;
Mangum, JH ;
Pappas, TN ;
Harpole, DH ;
D'Amico, TA .
ANNALS OF THORACIC SURGERY, 2004, 78 (04) :1170-1176
[4]   Reporting of Short-Term Clinical Outcomes After Esophagectomy A Systematic Review [J].
Blencowe, Natalie S. ;
Strong, Sean ;
McNair, Angus G. K. ;
Brookes, Sara T. ;
Crosby, Tom ;
Griffin, S. Michael ;
Blazeby, Jane M. .
ANNALS OF SURGERY, 2012, 255 (04) :658-666
[5]   Complete Barrett's Eradication Endoscopic Mucosal Resection: An Effective Treatment Modality for High-Grade Dysplasia and Intramucosal Carcinoma-An American Single-Center Experience [J].
Chennat, Jennifer ;
Konda, Vani J. A. ;
Ross, Andrew S. ;
de Tejada, Alberto Herreros ;
Noffsinger, Amy ;
Hart, John ;
Lin, Shang ;
Ferguson, Mark K. ;
Posner, Mitchell C. ;
Waxman, Irving .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2009, 104 (11) :2684-2692
[6]   Adenocarcinoma of the esophagus and cardia: A review of the disease and its treatment [J].
DeMeester, SR .
ANNALS OF SURGICAL ONCOLOGY, 2006, 13 (01) :12-30
[7]  
Djärv T, 2012, EXPERT REV GASTROENT, V6, P115, DOI [10.1586/EGH.11.91, 10.1586/egh.11.91]
[8]   Trends in Hospital Volume and Operative Mortality for High-Risk Surgery [J].
Finks, Jonathan F. ;
Osborne, Nicholas H. ;
Birkmeyer, John D. .
NEW ENGLAND JOURNAL OF MEDICINE, 2011, 364 (22) :2128-2137
[9]  
Gen P, 2008, CANCER-AM CANCER SOC, V112, P1020, DOI [10.1002/cncr23265, 10.1002/cncr.23265]
[10]   Prediction Model of Lymph Node Metastasis in Superficial Esophageal Adenocarcinoma and Squamous Cell Cancer Including D2-40 Immunostaining [J].
Gockel, I. ;
Domeyer, M. ;
Sgourakis, G. G. ;
Schimanski, C. C. ;
Moehler, M. ;
Kirkpatrick, C. J. ;
Lang, H. ;
Junginger, Th. ;
Hansen, T. .
JOURNAL OF SURGICAL ONCOLOGY, 2009, 100 (03) :191-198