Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2018; 24(45): 5154-5166
Published online Dec 7, 2018. doi: 10.3748/wjg.v24.i45.5154
Clinicopathological parameters predicting recurrence of pT1N0 esophageal squamous cell carcinoma
Li-Yan Xue, Xiu-Min Qin, Yong Liu, Jun Liang, Hua Lin, Xue-Min Xue, Shuang-Mei Zou, Mo-Yan Zhang, Bai-Hua Zhang, Zhou-Guang Hui, Zi-Tong Zhao, Li-Qun Ren, Yue-Ming Zhang, Xiu-Yun Liu, Yan-Ling Yuan, Jian-Ming Ying, Shu-Geng Gao, Yong-Mei Song, Gui-Qi Wang, Sanford M Dawsey, Ning Lu
Li-Yan Xue, Xue-Min Xue, Shuang-Mei Zou, Li-Qun Ren, Xiu-Yun Liu, Yan-Ling Yuan, Jian-Ming Ying, Ning Lu, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Li-Yan Xue, Center for Cancer Precision Medicine, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Xiu-Min Qin, Yong Liu, Yue-Ming Zhang, Gui-Qi Wang, Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Jun Liang, Zhou-Guang Hui, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Hua Lin, Department of Medical Record, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Mo-Yan Zhang, Bai-Hua Zhang, Shu-Geng Gao, Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Bai-Hua Zhang, The 2nd Department of Thoracic Surgery, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, CSU, Changsha 410006, Hunan Province, China
Zi-Tong Zhao, Yong-Mei Song, State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Li-Qun Ren, Department of Pathology, Chengde Medical College, Chengde 067000, Hebei Province, China
Sanford M Dawsey, Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, United States
Author contributions: Xue LY and Lu N designed the study and drafted the manuscript; Qin XM, Liu Y, Lin H, and Zhang BH collected the follow-up data; Xue LY and Xue XM performed statistical analyses; Xue LY, Zou SM, and Ren LQ reviewed the pathologic slides; Liu XY and Yuan YL did the immunohistochemistry; Dawsey SM, Liang J, Zhang MY, Hui ZG, Zhao ZT, Zhang YM, Ying JM, Gao SG, Song YM, and Wang GQ made critical revision of the manuscript for important intellectual content.
Supported by the National Natural Science Foundation of China, No. 81402463; CAMS Innovation Fund for Medical Sciences (CIFMS), No. 2016-I2M-1-001 and No. 2016-I2M-3-005; and the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences, No. 2016ZX310178 and No. 2017PT32001.
Correspondence author to: Ning Lu, MD, Chief Doctor, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China. nlu03@126.com
Telephone: +86-10-87788435 Fax: +86-10-67702630
Received: August 31, 2018
Peer-review started: September 2, 2018
First decision: October 14, 2018
Revised: October 22, 2018
Accepted: November 13, 2018
Article in press: November 13, 2018
Published online: December 7, 2018
ARTICLE HIGHLIGHTS
Research background

The prognosis of superficial (T1) esophageal squamous cell carcinoma (ESCC) is poor, compared with T1 gastric or colorectal cancer. The unfavorable prognosis of patients with T1 ESCC is due to high rates of both synchronous and metachronous metastases. Recurrences of T1 ESCC after esophagectomy are usually metachronous metastases. When recurrence occurs, the prognosis is similar in patients who were node-negative or node-positive at the time of the original surgery. However, only a few studies have evaluated the clinicopathological characteristics associated with an increased risk of a postoperative recurrence in pT1N0 ESCC patients. No previous studies have separately evaluated the clinicopathological characteristics that are associated with distant recurrence or early recurrence in pT1N0 ESCC patients.

Research motivation

The identification of pT1N0 ESCC cases at high risk for recurrence is a very important and challenging aspect of the clinical management of these patients, to ensure appropriate use and maximum benefit of additional therapies.

Research objectives

To investigate the clinicopathological characteristics that are associated with recurrence, distant recurrence, and early recurrence, in order to provide clues to optimal individual therapy.

Research methods

Clinicopathological characteristics associated with any recurrence or distant recurrence were evaluated using univariate and multivariate Cox proportional hazards models. Early recurrence (≤ 24 mo) and correlated parameters were assessed using univariate and multivariate logistic regression models.

Research results

We have identified certain clinicopathological features that are associated with an increased risk of tumor recurrence in pT1N0 thoracic ESCC patients. A nomogram including tumor location, angiolymphatic invasion, and submucosal invasion thickness can be used to predict the likelihood of recurrence-free survival at different times after surgery. Patients with an upper thoracic tumor location and/or angiolymphatic invasion have a higher risk of distant recurrence. Patients with an upper thoracic tumor location, angiolymphatic invasion, submucosal invasion thickness, and an greater diameter of the largest single tongue of invasion have a higher risk of early recurrence. Additional long-term follow-up studies are needed to confirm these findings.

Research conclusions

We evaluated the clinicopathological characteristics associated with an increased risk of a postoperative recurrence and separately evaluated the clinicopathological characteristics that are associated with distant recurrence or early recurrence in pT1N0 ESCC patients. This study should help clinicians select a subset of these patients who need especially close postoperative surveillance and/or chemoradiotherapy.

Research perspectives

Risk of tumor recurrence in pT1N0 ESCC patients can be predicted using certain clinicopathological features. This should be confirmed in more prospective studies and multi-center studies.