接受手术和内镜治疗的 T1b 食管腺癌患者淋巴结转移和生存率的预测因素:监测、流行病学和最终结果数据库分析》。

IF 6.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
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引用次数: 0

摘要

背景和目的:有关T1b食管腺癌(EAC)的内镜治疗(ET)联合或不联合化放疗(CRT)的长期疗效的数据有限。我们的目的是确定T1b食管腺癌淋巴结转移(LNM)的风险因素,并评估所选治疗方式对总生存期(OS)和癌症特异性生存期(CSS)的影响:我们利用监测流行病学和最终结果数据库分析了2004年至2018年期间确诊的组织学确诊T1b EAC患者。以T1bN0M0分期为重点,我们将患者分为两组:ET组(n=174)和手术组(n=769),并计算了OS和CSS率:在1418例T1b EAC患者中,有228例(16.1%)在确诊时出现LNM。LNM的显著风险因素包括肿瘤分化不良和病灶大小≥20毫米。对于T1bN0M0病例,2009年至2018年期间,ET的实施很普遍(OR 4.3),尤其是年龄≥65岁(OR 3.1)、肿瘤大小Conclusion的患者:在T1b EAC中,肿瘤大小≥20mm和分化不良是LNM的显著风险因素。对于精心选择的 T1bN0M0 病变,ET 的 CSS 结果与手术相当。CRT并没有为这些病灶带来额外的生存获益;然而,这一发现还需要大规模的研究来验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictors for lymph node metastasis and survival of patients with T1b esophageal adenocarcinoma treated with surgery and endoscopic therapy: an analysis of the Surveillance, Epidemiology, and End Results database

Background and Aims

Limited data exist regarding the long-term outcomes of endoscopic therapy (ET) with or without chemoradiation therapy (CRT) for T1b esophageal adenocarcinoma (EAC). Our aim was to identify the risk factors for lymph node metastasis (LNM) in T1b EAC and assess how the chosen treatment modality affects overall survival (OS) and cancer-specific survival (CSS).

Methods

We analyzed patients with histologically confirmed T1b EAC diagnosed between 2004 and 2018 using the Surveillance, Epidemiology, and End Results database. Focusing on T1bN0M0 staging, the patients were divided into 2 groups (ET [n = 174] and surgery [n = 769]), and OS and CSS rates were calculated.

Results

Of 1418 patients with T1b EAC, 228 cases (16.1%) exhibited LNM at diagnosis. Notable risk factors for LNM included poorly differentiated tumor and lesion size ≥20 mm. For T1bN0M0 cases, ET was commonly performed from 2009 to 2018 (odds ratio [OR], 4.3), especially for patients aged ≥65 years (OR, 3.1) with tumor size <20 mm (OR, 2.3). During the median 50 months of follow-up, age ≥65 years (hazard ratio [HR], 1.9), ET (HR, 1.5), and CRT (HR, 1.4) were associated with poorer OS. Factors linked to decreased CSS were age ≥65 years (subhazard ratio [SHR], 1.6), poorly differentiated tumors (SHR, 1.5), and CRT (SHR, 1.5).

Conclusions

In T1b EAC, tumor size ≥20 mm and poor differentiation are notable risk factors for LNM. ET exhibited comparable CSS outcomes to surgery for carefully selected T1bN0M0 lesions. CRT did not provide additional survival benefit for these lesions; however, large-scale studies are required to validate this finding.
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来源期刊
Gastrointestinal endoscopy
Gastrointestinal endoscopy 医学-胃肠肝病学
CiteScore
10.30
自引率
7.80%
发文量
1441
审稿时长
38 days
期刊介绍: Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.
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