Treatment allocation in patients with early-stage esophageal adenocarcinoma: Prevalence and predictors of lymph node involvement

被引:37
作者
Gamboa, Anthony M. [1 ]
Kim, Sungjin [2 ]
Force, Seth D. [3 ]
Staley, Charles A. [4 ]
Woods, Kevin E. [5 ]
Kooby, David A. [4 ]
Maithel, Shishir K. [4 ]
Luke, Jennifer A. [6 ]
Shaffer, Katherine M. [6 ]
Dacha, Sunil [1 ]
Saba, Nabil F. [7 ]
Keilin, Steven A. [1 ]
Cai, Qiang [1 ]
El-Rayes, Bassel F. [7 ]
Chen, Zhengjia [2 ,7 ]
Willingham, Field F. [1 ]
机构
[1] Emory Univ, Div Digest Dis, Dept Med, Sch Med, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
[2] Emory Univ, Rollins Sch Publ Hlth, Dept Biostat & Bioinformat, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
[3] Emory Univ, Sch Med, Dept Surg, Div Cardiothorac Surg, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
[4] Emory Univ, Winship Canc Inst, Dept Surg, Div Surg Oncol, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
[5] Canc Treatment Ctr Amer, Intervent Endoscopy Gastroenterol & Nutr, Newnan, GA USA
[6] Emory Univ, Sch Med, Dept Med, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
[7] Emory Univ, Winship Canc Inst, Hematol & Med Oncol, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
基金
美国国家卫生研究院;
关键词
Barrett esophagus; early esophageal cancer; esophageal adenocarcinoma; esophageal cancer; endoscopic mucosal surgical resection; HIGH-GRADE DYSPLASIA; ENDOSCOPIC MUCOSAL RESECTION; BARRETTS-ESOPHAGUS; INTRAEPITHELIAL NEOPLASIA; SURGICAL RESECTION; CURATIVE TREATMENT; EARLY CANCER; CARCINOMA; METASTASIS; RISK;
D O I
10.1002/cncr.30040
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUNDIn considering treatment allocation for patients with early esophageal adenocarcinoma, the incidence of lymph node metastasis is a critical determinant; however, this has not been well defined or stratified by the relevant clinical predictors of lymph node spread. METHODSData from the Surveillance, Epidemiology, and End Results database of the National Cancer Institute were abstracted from 2004 to 2010 for patients with early-stage esophageal adenocarcinoma. The incidence of lymph node involvement for patients with Tis, T1a, and T1b tumors was examined and was stratified by predictors of spread. RESULTSA total of 13,996 patients with esophageal adenocarcinoma were evaluated. Excluding those with advanced, metastatic, and/or invasive (T2-T4) disease, 715 patients with Tis, T1a, and T1b tumors were included. On multivariate analysis, tumor grade (odds ratio [OR], 2.76; 95% confidence interval [95% CI], 1.58-4.82 [P<.001]), T classification (OR, 0.47; 95% CI, 0.24-0.91 [P =.025]), and tumor size (OR, 2.68; 95% CI, 1.48-4.85 [P = .001]) were found to be independently associated with lymph node metastases. There was no lymph node spread noted with Tis tumors. For patients with low-grade (well or moderately differentiated) tumors measuring <2 cm in size, the risk of lymph node metastasis was 1.7% for T1a (P<.001) and 8.6% for T1b (P = .001) tumors. CONCLUSIONSFor patients with low-grade Tis or T1 tumors measuring 2 cm in size, the incidence of lymph node metastasis appears to be comparable to the mortality rate associated with esophagectomy. For highly selected patients with early esophageal adenocarcinomas, the results of the current study support the recommendation that local endoscopic resection can be considered as an alternative to surgical management when followed by rigorous endoscopic and radiographic surveillance. Cancer 2016;122:2150-7. (c) 2016 American Cancer Society. In a large national sample of patients with early, low-grade esophageal cancers, the prevalence of lymph node metastasis is low. For selected patients, these data support the use of local endoscopic surgical resection as an alternative to surgical management.
引用
收藏
页码:2150 / 2157
页数:8
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