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Gotink AW, van de Ven SEM, Ten Kate FJC, et al. Individual risk calculator to predict lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma: a multicenter cohort study. Endoscopy. 2021;doi: 10.1055/a-1399-4989.
Gotink, A. W., van de Ven, S. E. M., Ten Kate, F. J. C., Nieboer, D., Suzuki, L., Weusten, B. L. A. M., Brosens, L. A. A., van Hillegersberg, R., Alvarez Herrero, L., Seldenrijk, C. A., Alkhalaf, A., Moll, F. C. P., Schoon, E. J., van Lijnschoten, I., Tang, T. J., van der Valk, H., Nagengast, W. B., Kats-Ugurlu, G., Plukker, J. T. M., Houben, M. H. M. G., van der Laan, J. S., Pouw, R. E., Bergman, J. J. G. H. M., Meijer, S. L., van Berge Henegouwen, M. I., Wijnhoven, B. P. L., de Jonge, P. J. F., Doukas, M., Bruno, M. J., Biermann, K., & Koch, A. D. (2021). Individual risk calculator to predict lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma: a multicenter cohort study. Endoscopy, . https://doi.org/10.1055/a-1399-4989
Gotink, Annieke W, et al. "Individual risk calculator to predict lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma: a multicenter cohort study." Endoscopy vol. (2021). doi: https://doi.org/10.1055/a-1399-4989
Gotink AW, van de Ven SEM, Ten Kate FJC, Nieboer D, Suzuki L, Weusten BLAM, Brosens LAA, van Hillegersberg R, Alvarez Herrero L, Seldenrijk CA, Alkhalaf A, Moll FCP, Schoon EJ, van Lijnschoten I, Tang TJ, van der Valk H, Nagengast WB, Kats-Ugurlu G, Plukker JTM, Houben MHMG, van der Laan JS, Pouw RE, Bergman JJGHM, Meijer SL, van Berge Henegouwen MI, Wijnhoven BPL, de Jonge PJF, Doukas M, Bruno MJ, Biermann K, Koch AD. Individual risk calculator to predict lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma: a multicenter cohort study. Endoscopy. 2021 Feb 24; doi: 10.1055/a-1399-4989. Epub 2021 Feb 24. PMID: 33626582.
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Endoscopy. 2021 Feb 24; doi: 10.1055/a-1399-4989. Epub 2021 Feb 24.

Individual risk calculator to predict lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma: a multicenter cohort study.

Endoscopy

Annieke W Gotink, Steffi E M van de Ven, Fiebo J C Ten Kate, Daan Nieboer, Lucia Suzuki, Bas L A M Weusten, Lodewijk A A Brosens, Richard van Hillegersberg, Lorenza Alvarez Herrero, Cees A Seldenrijk, Alaa Alkhalaf, Freek C P Moll, Erik J Schoon, Ineke 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 Jan F de Jonge, Michael Doukas, Marco J Bruno, Katharina Biermann, Arjun D Koch

Affiliations

  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.

PMID: 33626582 DOI: 10.1055/a-1399-4989

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.

Conflict of interest statement

A. D. Koch has received consultancy fee from ERBE Elektromedizin and Pentax Medical. He has received research support from Dr Falk Pharma. M. J. Bruno is a consultant for Boston Scientific, Cook Medic

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