Annieke W Gotink1, Steffi E M van de Ven1, Fiebo J C Ten Kate2,3, Daan Nieboer4, Lucia Suzuki2, Bas L A M Weusten5,6, Lodewijk A A Brosens7, Richard van Hillegersberg8, Lorenza Alvarez Herrero6, Cees A Seldenrijk9, Alaa Alkhalaf10, Freek C P Moll3, Erik J Schoon11, Ineke van Lijnschoten12, Thjon J Tang13, Hans van der Valk14, Wouter B Nagengast15, Gursah Kats-Ugurlu16, John T M Plukker17, Martin H M G Houben18, Jaap S van der Laan19, Roos E Pouw20, Jacques J G H M Bergman20, Sybren L Meijer21, Mark I van Berge Henegouwen22, Bas P L Wijnhoven23, Pieter Jan F de Jonge1, Michael Doukas2, Marco J Bruno1, Katharina Biermann2, Arjun D Koch1. 1. Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands. 2. Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands. 3. Department of Pathology, Isala Clinics, Zwolle, the Netherlands. 4. Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands. 5. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands. 6. Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands. 7. Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands. 8. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. 9. Department of Pathology, Pathology DNA, St. Antonius Hospital, Nieuwegein, the Netherlands. 10. Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands. 11. Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands. 12. Department of Pathology, PAMM, Eindhoven, the Netherlands. 13. Department of Gastroenterology and Hepatology, Ijsselland Hospital, Capelle aan den Ijssel, the Netherlands. 14. Department of Pathology, Ijselland Hospital, Capelle aan den Ijssel, the Netherlands. 15. Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands. 16. Department of Pathology, University Medical Center Groningen, Groningen, the Netherlands. 17. Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands. 18. Department of Gastroenterology and Hepatology, Haga Teaching Hospital, Den Haag, the Netherlands. 19. Department of Pathology, Haga Teaching Hospital, Den Haag, the Netherlands. 20. Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, Amsterdam, the Netherlands. 21. Department of Pathology, Amsterdam University Medical Centers, Amsterdam, the Netherlands. 22. Department of Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands. 23. Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
Abstract
BACKGROUND: Lymph node metastasis (LNM) is possible after endoscopic resection of early esophageal adenocarcinoma (EAC). This study aimed to develop and internally validate a prediction model that estimates the individual risk of metastases in patients with pT1b EAC. METHODS: A nationwide, retrospective, multicenter cohort study was conducted in patients with pT1b EAC treated with endoscopic resection and/or surgery between 1989 and 2016. The primary end point was presence of LNM in surgical resection specimens or detection of metastases during follow-up. All resection specimens were histologically reassessed by specialist gastrointestinal pathologists. Subdistribution hazard regression analysis was used to develop the prediction model. The discriminative ability of this model was assessed using the c-statistic. RESULTS: 248 patients with pT1b EAC were included. Metastases were seen in 78 patients, and the 5-year cumulative incidence was 30.9 % (95 % confidence interval [CI] 25.1 %-36.8 %). The risk of metastases increased with submucosal invasion depth (subdistribution hazard ratio [SHR] 1.08, 95 %CI 1.02-1.14, for every increase of 500 μm), lymphovascular invasion (SHR 2.95, 95 %CI 1.95-4.45), and for larger tumors (SHR 1.23, 95 %CI 1.10-1.37, for every increase of 10 mm). The model demonstrated good discriminative ability (c-statistic 0.81, 95 %CI 0.75-0.86). CONCLUSIONS: A third of patients with pT1b EAC experienced metastases within 5 years. The probability of developing post-resection metastases was estimated with a personalized predicted risk score incorporating tumor invasion depth, tumor size, and lymphovascular invasion. This model requires external validation before implementation into clinical practice. Thieme. All rights reserved.
BACKGROUND: Lymph node metastasis (LNM) is possible after endoscopic resection of early esophageal adenocarcinoma (EAC). This study aimed to develop and internally validate a prediction model that estimates the individual risk of metastases in patients with pT1b EAC. METHODS: A nationwide, retrospective, multicenter cohort study was conducted in patients with pT1b EAC treated with endoscopic resection and/or surgery between 1989 and 2016. The primary end point was presence of LNM in surgical resection specimens or detection of metastases during follow-up. All resection specimens were histologically reassessed by specialist gastrointestinal pathologists. Subdistribution hazard regression analysis was used to develop the prediction model. The discriminative ability of this model was assessed using the c-statistic. RESULTS: 248 patients with pT1b EAC were included. Metastases were seen in 78 patients, and the 5-year cumulative incidence was 30.9 % (95 % confidence interval [CI] 25.1 %-36.8 %). The risk of metastases increased with submucosal invasion depth (subdistribution hazard ratio [SHR] 1.08, 95 %CI 1.02-1.14, for every increase of 500 μm), lymphovascular invasion (SHR 2.95, 95 %CI 1.95-4.45), and for larger tumors (SHR 1.23, 95 %CI 1.10-1.37, for every increase of 10 mm). The model demonstrated good discriminative ability (c-statistic 0.81, 95 %CI 0.75-0.86). CONCLUSIONS: A third of patients with pT1b EAC experienced metastases within 5 years. The probability of developing post-resection metastases was estimated with a personalized predicted risk score incorporating tumor invasion depth, tumor size, and lymphovascular invasion. This model requires external validation before implementation into clinical practice. Thieme. All rights reserved.
Authors: Steffi E M van de Ven; Lucia Suzuki; Annieke W Gotink; Fiebo J C Ten Kate; Daan Nieboer; Bas L A M Weusten; Lodewijk A A Brosens; Richard van Hillegersberg; Lorenza Alvarez Herrero; Cees A Seldenrijk; Alaa Alkhalaf; Freek C P Moll; Wouter Curvers; Ineke G van Lijnschoten; Thjon J Tang; Hans van der Valk; Wouter B Nagengast; Gursah Kats-Ugurlu; John T M Plukker; Martin H M G Houben; Jaap S van der Laan; Roos E Pouw; Jacques J G H M Bergman; Sybren L Meijer; Mark I van Berge Henegouwen; Bas P L Wijnhoven; Pieter J F de Jonge; Michael Doukas; Marco J Bruno; Katharina Biermann; Arjun D Koch Journal: United European Gastroenterol J Date: 2021-10-05 Impact factor: 4.623