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Predicting lymph node metastases in early esophageal adenocarcinoma using a simple scoring system
Lawrence Lee1, Ulrich Ronellenfitsch, Wayne L Hofstetter
1Division of Thoracic Surgery, McGill University Health Centre, Montreal, Canada.
Journal of the American College of Surgeons
|May 11, 2013
Summary
A new scoring system helps predict lymph node metastases (LNM) in early esophageal adenocarcinoma. This tool aids decisions for endoscopic resection, identifying patients with negligible LNM risk.
Area of Science:
- Oncology
- Gastroenterology
- Surgical Pathology
Background:
- Endoscopic resection offers organ preservation for early esophageal adenocarcinoma.
- Patient selection is critical, requiring identification of individuals with minimal risk of lymph node metastases (LNM).
Purpose of the Study:
- To develop a straightforward scoring system for predicting LNM in T1 esophageal adenocarcinoma.
- To aid clinical decision-making regarding endoscopic resection versus more invasive treatments.
Main Methods:
- Analysis of primary esophagectomies for T1 esophageal adenocarcinoma without neoadjuvant therapy across five institutions (2000-2011).
- Comparison of patient and pathologic characteristics between patients with and without LNM.
- Development of a weighted scoring system using multivariate analysis of surgical pathology variables.
Main Results:
- A total of 258 patients were analyzed; LNM incidence was 7% for T1a and 26% for T1b.
- Tumor size and lymphovascular invasion were the strongest independent predictors of LNM.
- A scoring system incorporating size, depth of invasion, differentiation, and lymphovascular invasion accurately estimated LNM probability.
Conclusions:
- A simple, accurate scoring system was developed to estimate LNM risk in T1 esophageal adenocarcinoma.
- This system can assist clinicians in determining the suitability of endoscopic resection.
