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Mei Y, Gao J, Zhang B, Feng T, Wu W, Zhu Z, Zhu Z. Latest guideline of endoscopic submucosal dissection of early gastric cancer may not be suitable for Chinese patients: retrospective study findings from two centers. Surg Endosc 2024:10.1007/s00464-024-11293-w. [PMID: 39327293 DOI: 10.1007/s00464-024-11293-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 09/13/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND To analyze the diagnostic efficiency of the four absolute endoscopic submucosal dissection (ESD) indications for lymph node metastasis (LNM) of Chinese patients with early gastric cancer (EGC). METHODS We retrospectively analyzed EGC patients who underwent radical D2 gastrectomy from January 2019 to December 2022. We evaluated the rate of LNM, false-negative rate, and negative predictive value of the four ESD indications. RESULTS Of enrolled 2722 EGC patients, 388 (14.3%) patients presented LNM. Tumor size > 2 cm, ulceration, submucosal invasion, undifferentiated type, and lymphovascular invasion were independent risk factors of LNM in patients with EGC. 1062 (39%) cases of EGC conformed to the four EDS indications; however, 4% of them had LNM. 451 cases were fully in accord with the fourth ESD indication (undifferentiated intramucosal carcinoma without ulceration and a maximum lesion diameter of ≤ 2 cm), and 35 of them had LNM, with a false-negative rate (FNR) of 9.02% and a negative predictive value (NPV) of 92.24%. There was significant difference among the four indications in terms of the rate of LNM (1.0% vs 1.5% vs 1.3% vs 7.8%, P < 0.001), FNR (1.03% vs 0.52% vs 0.26% vs 9.02%, P < 0.001), and NPV (98.99% vs 98.53% vs 98.75% vs 92.24%, P < 0.001). CONCLUSION Overall, the fourth ESD indication was associated with a high rate of LNM compared to the other three indications. Thus, it might not be safe to classify it as an absolute indication in Chinese patients with EGC.
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Affiliation(s)
- Yu Mei
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jianpeng Gao
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Benyan Zhang
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Tienan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wei Wu
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhenggang Zhu
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Zhenglun Zhu
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Wang J, Liu X, Mao T, Xu Z, Li H, Li X, Zhou X, Chu Y, Ren M, Tian Z. A practical nomogram included hyperlipidemia for predicting lymph node metastasis in patients with superficial esophageal squamous cell carcinoma. Medicine (Baltimore) 2023; 102:e35891. [PMID: 37986324 PMCID: PMC10659609 DOI: 10.1097/md.0000000000035891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 11/22/2023] Open
Abstract
To select an optimal treatment, it is crucial to evaluate the risk of lymph node metastasis (LNM) in patients with superficial esophageal squamous cell carcinoma (SESCC). The research aimed to explore more risk factors than before and construct a practical nomogram to predict LNM in patients with SESCC. We retrospectively reviewed 1080 patients diagnosed with esophageal cancer who underwent esophagectomy with lymphadenectomy between January 2013 and October 2021 at the Affiliated Hospital of Qingdao University. The clinical parameters, endoscopic features, and pathological characteristics of the 123 patients that were finally enrolled in this study were collected. The independent risk factors for LNM were determined using univariate and multivariate analyses. Using these factors, a nomogram was constructed to predict LNM. LNM was observed in 21 patients. Univariate analysis showed that the absence or presence of hypertriglyceridemia, tumor location, lesion size, macroscopic type, invasion depth, differentiation, absence or presence of lymphovascular invasion (LVI), and perineural invasion were significantly associated with LNM. According to the multivariate analysis, hypertriglyceridemia, tumors located in the lower thoracic esophagus, lesion size > 20 mm, submucosal invasion, and LVI were independent risk factors for LNM. A nomogram was established using these 5 factors. It showed good calibration and discrimination. Hypertriglyceridemia, tumors located in the lower thoracic esophagus, lesion size > 20 mm, submucosal invasion, and LVI were independent risk factors for LNM. A nomogram was constructed using these 5 factors. This model can help clinicians assess the risk of LNM in patients with SESCC for optimal treatment selection.
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Affiliation(s)
- Jing Wang
- Department of Gastroenterology, the People’s Hospital of Rizhao, Rizhao, Shandong Province, China
| | - Xiangji Liu
- Department of Gastroenterology, the People’s Hospital of Rizhao, Rizhao, Shandong Province, China
| | - Tao Mao
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Zitong Xu
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Hanqing Li
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xiaoyu Li
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xuan Zhou
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yuning Chu
- Department of Nutriology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Minghan Ren
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Zibin Tian
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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Li Y, Cheng Q, Xiong Z, Paiboonrungruang C, Adekoya T, Li Y, Chen X. Lymphatic Drainage System and Lymphatic Metastasis of Cancer Cells in the Mouse Esophagus. Dig Dis Sci 2023; 68:803-812. [PMID: 35727424 PMCID: PMC9938949 DOI: 10.1007/s10620-022-07586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/02/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Lymphatic metastasis is commonly seen in patients with esophageal squamous cell carcinoma (ESCC). Both lymphatic metastasis and the number of involved nodes are prognostic for post-operative survival. To better understand lymphatic metastasis of ESCC, there is a need to develop proper animal models. AIMS This study is aimed to characterize the morphology and function of the lymphatic drainage system in the mouse esophagus. METHODS Immunostaining and fluorescence imaging were used to visualize the lymphatic drainage system in the mouse esophagus. Tracers and cancer cells were orthotopically inoculated into the submucosa of the mouse esophagus to mimic lymphatic metastasis of T1 ESCC. RESULTS Using immunostaining of a lymphatic vessel marker (LYVE1), we found that lymphatic vessels were located in the submucosa and muscularis propria of the mouse esophagus, similar to the human esophagus. In the esophagus of ProxTom mice expressing tdTomato in the lymphatic vessels, we discovered a microscopic meshwork of lymphatic vessels. Functionally, orthotopically inoculated tracers (Indian ink and FITC-dextran) were drained from the submucosa into peri-esophageal lymph nodes via lymphatic vessels. Orthotopically inoculated mouse cancer cells (LLC-eGFP, MOC2) metastasized from the submucosa to lymphatic vessels, peri-esophageal lymph nodes, and distant organs (liver and lung) in immunocompetent mice. Similarly, in immunodeficient mice, orthotopically inoculated human ESCC cells (KYSE450-eGFP-Luc) metastasized via the same route. CONCLUSION We have characterized the morphology and function of the lymphatic drainage system of the mouse esophagus. These observations lay a foundation for mechanistic and therapeutic studies on lymphatic metastasis of T1 ESCC.
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Affiliation(s)
- Yahui Li
- Cancer Research Program, Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, 700 George Street, Durham, NC, 27707, USA
| | - Qing Cheng
- Cancer Research Program, Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, 700 George Street, Durham, NC, 27707, USA
| | - Zhaohui Xiong
- Cancer Research Program, Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, 700 George Street, Durham, NC, 27707, USA
| | - Chorlada Paiboonrungruang
- Cancer Research Program, Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, 700 George Street, Durham, NC, 27707, USA
| | - Timothy Adekoya
- Cancer Research Program, Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, 700 George Street, Durham, NC, 27707, USA
| | - Yong Li
- Cancer Research Program, Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, 700 George Street, Durham, NC, 27707, USA
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital of Chinese Academy of Medical Sciences, 17 Panjiayuan Nanli Road, Beijing, 100021, China
| | - Xiaoxin Chen
- Cancer Research Program, Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, 700 George Street, Durham, NC, 27707, USA.
- Center for Gastrointestinal Biology and Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Chen H, Wu J, Guo W, Yang L, Lu L, Lin Y, Wang X, Zhang Y, Chen X. Clinical models to predict lymph nodes metastasis and distant metastasis in newly diagnosed early esophageal cancer patients: A population-based study. Cancer Med 2023; 12:5275-5292. [PMID: 36205033 PMCID: PMC10028124 DOI: 10.1002/cam4.5334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with early esophageal cancer (EC) receive individualized therapy based on their lymph node metastasis (LNM) and distant metastasis (DM) status; however, deficiencies in current clinical staging techniques and the issue of cost-effectiveness mean LNM and DM often go undetected preoperatively. We aimed to develop three clinical models to predict the likelihood of LNM, DM, and prognosis in patients with early EC. METHOD The Surveillance, Epidemiology, and End Results database was queried for T1 EC patients from 2004 to 2015. Multivariable logistic regression and Cox proportional hazards models were used to recognize the risk factors of LNM and DM, predict overall survival (OS), and develop relevant nomograms. Receiver operating characteristic (ROC)/concordance index and calibration curves were used to evaluate the discrimination and accuracy of the three nomograms. Decision curve analyses (DCAs), clinical impact curves, and subgroups based on model scores were used to determine clinical practicability. RESULTS The area under the curve of the LNM and DM nomograms were 0.668 and 0.807, respectively. The corresponding C-index of OS nomogram was 0.752. Calibration curves and DCA showed an effective predictive accuracy and clinical applicability. In patients with T1N0M0 EC, surgery alone (p < 0.01) proved a survival advantage. Chemotherapy and radiotherapy indicated a better prognosis in the subgroup analysis for T1 EC patients with LNM or DM. CONCLUSIONS We created three nomograms to predict the likelihood of LNM, DM, and OS probability in patients with early EC using a generalizable dataset. These useful visual tools could help clinical physicians deliver appropriate perioperative care.
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Affiliation(s)
- Hong Chen
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, 350025, China
| | - Junxian Wu
- Department of Gastroenterology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Wanting Guo
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, 350025, China
| | - Lihang Yang
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, 350025, China
| | - Linbin Lu
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, 350025, China
| | - Yihong Lin
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, 350025, China
| | - Xuewen Wang
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, 350025, China
| | - Yan Zhang
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, 350025, China
| | - Xi Chen
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, 350025, China
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Abstract
Esophageal squamous cell carcinoma (ESCC) is common in the developing world with decreasing incidence in developed countries and carries significant morbidity and mortality. Major risk factors for ESCC development include significant use of alcohol and tobacco. Screening for ESCC can be recommended in high-risk populations living in highly endemic regions. The treatment of ESCC ranges from endoscopic resection therapy or surgery in localized disease to chemoradiotherapy in metastatic disease, and prognosis is directly related to the stage at diagnosis. New immunotherapies and molecular targeted therapies may improve the dismal survival outcomes in patients with metastatic ESCC.
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Affiliation(s)
- D Chamil Codipilly
- Division of Gastroenterology and Hepatology, Mayo Clinic, SMH Campus, 6 Alfred GI Unit, 200 1st Street South West, Rochester MN 55905, USA
| | - Kenneth K Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, SMH Campus, 6 Alfred GI Unit, 200 1st Street South West, Rochester MN 55905, USA.
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Abula G, Song WX, Liu H, Ren XF, Chen X. Prediction model for selection of adjuvant therapy population after endoscopic submucosal dissection for early esophageal lesions. Shijie Huaren Xiaohua Zazhi 2022; 30:587-598. [DOI: 10.11569/wcjd.v30.i13.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic treatment is the first choice for early esophageal lesions without obvious metastasis or infiltration, especially endoscopic submucosal dissection (ESD). However, the occurrence of non-curative resection, recurrence, or metastasis after ESD is inevitable, which may require adjuvant therapy such as additional surgery or chemora-diotherapy.
AIM To analyze the risk factors for additional surgery or chemora-diotherapy after ESD for early esophageal lesions, and explore the effect of curative resection on additional adjuvant therapy.
METHODS Patients who underwent ESD for stage T1 esophageal cancer (EC) and precancerous lesions were analyzed retrospectively. Postoperative recurrence, metastasis, and adjuvant treatment were followed, and a prediction model for adjuvant treatment population selection was established.
RESULTS Non-curative resection was correlated with patient age, proportion of lesions, and microscopic size(P < 0.05), among which the proportion of lesions > 2/3 (odds ratio [OR] = 7.958, P = 0.007) was an independent risk factor. Two of curative and ten of non-curative resection cases received additional treatment, indicating that further treatment after ESD might be required regardless of whether curative resection was performed. Patient age, proportion of lesions, lesion lifting, differentiation, vascular invasion, and tumor invasion depth were correlated with the need for further treatment (P < 0.05). Age ≥ 70 years (OR = 4.210, P = 0.049), poor lifting (OR = 18.171, P = 0.047), and depth of tumor up to SM2 (OR = 38.781, P = 0.012) were independent risk factors. The AUC of the nomogram model was 0.864 (95%CI: 0.766-0.962); the specificity and sensitivity were 95.8% and 75.0%, respectively. Calibration curve analysis, decision curve analysis, and Hosmer and Lemeshow test (χ2 = 1.5954, P = 0.991) showed that the predictive value of the model was acceptable.
CONCLUSION For patients with stage T1 EC and precancerous lesions, whether further surgery or chemoradiotherapy is needed after ESD should be comprehensively considered.
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Affiliation(s)
- Gulisitan Abula
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wen-Xuan Song
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hang Liu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xiang-Feng Ren
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
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Li W, Zhou Q, Liu W, Xu C, Tang ZR, Dong S, Wang H, Li W, Zhang K, Li R, Zhang W, Hu Z, Shibin S, Liu Q, Kuang S, Yin C. A Machine Learning-Based Predictive Model for Predicting Lymph Node Metastasis in Patients With Ewing's Sarcoma. Front Med (Lausanne) 2022; 9:832108. [PMID: 35463005 PMCID: PMC9020377 DOI: 10.3389/fmed.2022.832108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective In order to provide reference for clinicians and bring convenience to clinical work, we seeked to develop and validate a risk prediction model for lymph node metastasis (LNM) of Ewing’s sarcoma (ES) based on machine learning (ML) algorithms. Methods Clinicopathological data of 923 ES patients from the Surveillance, Epidemiology, and End Results (SEER) database and 51 ES patients from multi-center external validation set were retrospectively collected. We applied ML algorithms to establish a risk prediction model. Model performance was checked using 10-fold cross-validation in the training set and receiver operating characteristic (ROC) curve analysis in external validation set. After determining the best model, a web-based calculator was made to promote the clinical application. Results LNM was confirmed or unable to evaluate in 13.86% (135 out of 974) ES patients. In multivariate logistic regression, race, T stage, M stage and lung metastases were independent predictors for LNM in ES. Six prediction models were established using random forest (RF), naive Bayes classifier (NBC), decision tree (DT), xgboost (XGB), gradient boosting machine (GBM), logistic regression (LR). In 10-fold cross-validation, the average area under curve (AUC) ranked from 0.705 to 0.764. In ROC curve analysis, AUC ranged from 0.612 to 0.727. The performance of the RF model ranked best. Accordingly, a web-based calculator was developed (https://share.streamlit.io/liuwencai2/es_lnm/main/es_lnm.py). Conclusion With the help of clinicopathological data, clinicians can better identify LNM in ES patients. Risk prediction models established in this study performed well, especially the RF model.
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Affiliation(s)
- Wenle Li
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, China.,Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Qian Zhou
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Wencai Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chan Xu
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China.,Department of Dermatology, Xianyang Central Hospital, Xianyang, China
| | - Zhi-Ri Tang
- School of Physics and Technology, Wuhan University, Wuhan, China
| | - Shengtao Dong
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haosheng Wang
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, China
| | - Wanying Li
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Kai Zhang
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, China.,Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Rong Li
- The First Clinical Medical College, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Wenshi Zhang
- The First Clinical Medical College, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Zhaohui Hu
- Department of Spinal Surgery, Liuzhou People's Hospital, Liuzhou, China
| | - Su Shibin
- Department of Business Management, Xiamen Bank, Xiamen, China
| | - Qiang Liu
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Sirui Kuang
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
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Clinical Significance of Left Tracheobronchial Lymph Node Dissection in Thoracic Esophageal Squamous Cell Carcinoma. J Thorac Cardiovasc Surg 2022; 164:1210-1219.e3. [DOI: 10.1016/j.jtcvs.2022.02.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
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