The Use of Neural Networks in Identifying Risk Factors for Lymph Node Metastasis and Recommending Management of T1b Esophageal Cancer

Abstract

The objective of this study was to establish a prediction model of lymph node status in T1b esophageal carcinoma and define the best squamous and adenocarcinoma predictors. The literature lacks a satisfactory level of evidence of T1b esophageal cancer management. We performed an analysis pooling the effects of outcomes of 2098 patients enrolled into 37 retrospective studies using “neural networks” as data mining techniques. The percentages for lymph node, lymphatic (L1), and vascular (V1) invasion in Sm1 esophageal cancers were 24, 46, and 20 per cent, respectively. The same parameters apply to Sm2 with 34, 63, and 38 per cent as opposed to Sm3 with 51, 69, and 47 per cent. The respective number of patients with well, moderate, and poor histologic differentiation totaled 267, 752, and 582. The rank order of the predictors of lymph node positivity was, respectively: Grade III, (L1), (V1), Sm3 invasion, Sm2 invasion, and Sm1 invasion. Histologic-type squamous and adenocarcinoma (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were sm3 invasion and (V1). As concerns ADC, the most important predictor was (L1). Submucosal esophageal cancer should be managed with surgical resection. However, this is subject to the histologic type and presence of specific predictors that could well alter the perspective of multimodality management.

Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View

“…The incidence of nodal metastasis in esophageal SCC invading the submucosa (T1b) is reportedly 26% to 50%, while that of lesions limited to SM1 is 8% to 50%, and cases involving skipped metastasis are rare. 7 , 21 , 33 , 36 …”

“…Adenocarcinoma with submucosal invasion (T1b) involves metastatic lymph nodes in 27% to 41% of cases, and SM1 lesions are associated with nodal involvement in 0% to 22% of cases. 18 , 22 , 27 , 28 , 36 Leers et al 18 studied the prevalence of lymph node metastasis in patients with T1 esophageal adenocarcinoma and found that lymphovascular invasion, a tumor equal to or greater than 2 cm in size, and poor differentiation were all associated with an increased risk of submucosal invasion and lymph node metastasis.…”

“…Sgourakis et al 36 found that lymphovascular invasion was a principal predictor of lymph node metastasis in T1b esophageal cancer, and that the best predictors of lymph node metastasis were SM3 invasion and vascular invasion for submucosal SCC and lymphatic invasion for adenocarcinoma. However, they found no association between lymph node metastasis and invasion depth (SM1 vs. SM2 vs. SM3) in submucosal cancer.…”

The possibility of endoscopic treatment of cN0 submucosal esophageal cancer: results from a surgical cohort

“…Because the rates of lymph node metastasis with intramucosal (T1a) esophageal carcinomas are extremely low, endoscopic submucosal resection alone has become the standard treatment [1][2][3]. In contrast, T1b esophageal carcinomas with submucosal invasion have a much higher lymph node metastasis rate of approximately 12-54% [4][5][6][7]. Therefore, the standard treatment for submucosal lesions consists of radical resection of the esophageal cancer plus lymph node dissection.…”

Raf kinase inhibitor protein inhibits esophageal cancer cell invasion through downregulation of matrix metalloproteinase expression

“…For tumors to develop, the normal cellular homeostasis of the microenvironment is destroyed and is replaced by one that facilitates tumor cell growth. The presence of inflammatory cytokines in the tumor microenvironment also plays a critical role in tumor invasion (36)(37)(38)(39). Thus, maintaining the tumor microenvironment is a prerequisite for protecting or promoting the occurrence and development of tumors.…”