Risk of Lymph Node Metastasis in Patients with the Superficial Spreading Type of Esophageal Squamous Cell Carcinoma

Abstract

Background: Little is known about the clinicopathological characteristics of superficial spreading-type esophageal carcinoma extending ≥5 cm along the long axis of the esophagus. This study was aimed at investigating the frequency of lymph node metastasis (LNM) in patients with superficial spreading-type esophageal carcinoma. Methods: We reviewed the data of 320 patients with superficial esophageal squamous cell carcinoma who had undergone esophagectomy with lymph node dissection at our hospital between 1986 and 2010. The incidence of LNM was compared between the spreading (≥5 cm) and nonspreading (< 5 cm) types. Results: The multivariate analysis revealed significant differences in the likelihood of LNM depending on the lymphovascular invasion, the infiltrative growth pattern (INF)-c, and the depth. There was no difference in the LNM frequency between nonspreading and spreading type in the patients with epithelium (EP)-lamina propria, muscularis mucosa (MM)-submucosa (SM)1 and SM2/3 lesions. The frequencies of LNMs (nonspreading-type vs. spreading-type tumors) in the patients with MM-SM1 lesions were 7/47 (14.9%) versus 4/25 (16%) and those in the patients with SM2/3 lesions were 22/58 (37.9%) versus 4/14 (28.9%), when the lesions did not have lymphovascular invasion and INF-c. Conclusions: Endoscopic resection can be selected for EP-SM1 lesions, regardless of whether the lesions are of the spreading type or nonspreading type.

Machine learning models predict lymph node metastasis in patients with stage T1-T2 esophageal squamous cell carcinoma

“…The present study showed the feasibility of the ML models for predicting LNM in stage T1-T2 ESCC patients. Traditional logistic regression (LR) analysis showed that tumor length, tumor size, tumor location, T1 substage, differentiation, lymphovascular invasion(LVI), depth of tumor invasion, and macroscopic type were associated with LNM occurrence ( 11 , 14 , 35 – 39 ). Multivariate analysis demonstrated that poor differentiation, LVI, depth of tumor invasion, T1 substage, high-density lipoprotein cholesterol (HDL-C) level, and preoperative alanine aminotransferase/aspartate aminotransferase ratio (LSR) were significant independent risk factors for LNM ( 11 , 14 , 35 , 37 – 39 ).…”

“…Traditional logistic regression (LR) analysis showed that tumor length, tumor size, tumor location, T1 substage, differentiation, lymphovascular invasion(LVI), depth of tumor invasion, and macroscopic type were associated with LNM occurrence ( 11 , 14 , 35 – 39 ). Multivariate analysis demonstrated that poor differentiation, LVI, depth of tumor invasion, T1 substage, high-density lipoprotein cholesterol (HDL-C) level, and preoperative alanine aminotransferase/aspartate aminotransferase ratio (LSR) were significant independent risk factors for LNM ( 11 , 14 , 35 , 37 – 39 ). Hence, the twenty-six routinely available features extracted from patients, including clinical variables, hematological indicators and pathological variables, are feasible for predicting LNM.…”

“…were associated with LNM occurrence (11,14,(35)(36)(37)(38)(39). Multivariate analysis demonstrated that poor differentiation, LVI, depth of tumor invasion, T1 substage, high-density lipoprotein cholesterol (HDL-C) level, and preoperative alanine aminotransferase/aspartate aminotransferase ratio (LSR) were significant independent risk factors for LNM (11,14,35,(37)(38)(39).…”

Development and validation of a nomogram for preoperative prediction of lymph node metastasis in pathological T1 esophageal squamous cell carcinoma

“…In particular, LVSI has been proved to be an independent risk factor for LNM in ESCC patients. [3,16,[26][27][28][29] Tumor cells are isolated from tumor aggregates at the primary focus and then spread through lymphatic vessels or blood vessels. In this process, they may invade lymphatic vessels or blood vessels, [30] which is considered to be the initial step of LNM and distant metastasis.…”