Endoscopy 2020; 52(S 01): S127-S128
DOI: 10.1055/s-0040-1704392
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 11:00 – 13:00 Esophageal therapy: No limits?! Wicklow Meeting Room 3
© Georg Thieme Verlag KG Stuttgart · New York

INDIVIDUAL RISK CALCULATOR TO PREDICT LYMPH NODE METASTASES IN PATIENTS WITH SUBMUCOSAL (T1B) ESOPHAGEAL ADENOCARCINOMA: MULTICENTER COHORT STUDY

SEM van de Ven
1   Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
AW Gotink
1   Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
FJC Ten Kate
2   Erasmus Medical Center, Pathology, Rotterdam, Netherlands
,
D Nieboer
3   Erasmus Medical Center, Public Health, Rotterdam, Netherlands
,
BLAM Weusten
4   University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands
,
LAA Brosens
5   University Medical Center Utrecht, Pathology, Utrecht, Netherlands
,
R van Hillegersberg
6   University Medical Center Utrecht, Surgery, Utrecht, Netherlands
,
LA Herrero
7   Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands
,
CA Seldenrijk
8   Antonius Hospital, Pathology, Nieuwegein, Netherlands
,
A Alkhalaf
9   Isala Hospital, Gastroenterology and Hepatology, Zwolle, Netherlands
,
FCP Moll
10   Isala Hospital, Pathology, Zwolle, Netherlands
,
EJ Schoon
11   Catharina Hospital, Gastroenterology and Hepatology, Eindhoven, Netherlands
,
I van Lijnschoten
12   Catharina Hospital, Pathology, Eindhoven, Netherlands
,
T Tang
13   Ijselland Hospital, Gastroenterology and Hepatology, Capelle aan den Ijssel, Netherlands
,
H van der Valk
14   Ijselland Hospital, Pathology, Capelle aan den Ijssel, Netherlands
,
WB Nagengast
15   University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
,
G Kats-Ugurlu
16   University Medical Center Groningen, Pathology, Groningen, Netherlands
,
JTM Plukker
17   University Medical Center Groningen, Surgery, Groningen, Netherlands
,
MHMG Houben
18   Haga Hospital, Gastroenterology and Hepatology, Den Haag, Netherlands
,
J van der Laan
19   Haga Hospital, Pathology, Den Haag, Netherlands
,
RE Pouw
20   Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
JJGHM Bergman
20   Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
SL Meijer
21   Amsterdam UMC, Pathology, Amsterdam, Netherlands
,
MI van Berge Henegouwen
22   Amsterdam UMC, Surgery, Amsterdam, Netherlands
,
BPL Wijnhoven
23   Erasmus Medical Center, Surgery, Rotterdam, Netherlands
,
PJF de Jonge
1   Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
M Doukas
2   Erasmus Medical Center, Pathology, Rotterdam, Netherlands
,
MJ Bruno
1   Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
K Biermann
2   Erasmus Medical Center, Pathology, Rotterdam, Netherlands
,
AD Koch
1   Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

 
 

    Aims A prognostic model may help to identify patients at risk for lymph node metastases (LNM) in order to stratify between a conservative approach or additional surgery, after endoscopic resection of pT1b esophageal adenocarcinoma (EAC). The aim of this study was to develop a prediction model for the risk LNM or distant metastases in patients with pT1b EAC.

    Methods This is a nationwide, retrospective, multicenter cohort study in collaboration with the Netherlands Cancer Registry. All patients who were diagnosed with pT1b EAC and treated with endoscopic resection and/or surgery between 1989 and 2017 were included. Primary endpoints: the presence of LNM in surgically resected specimens (≥12 resected lymph nodes) or the development of pathologically confirmed LNM or distant metastases during follow-up. Histopathological reassessment of all resection specimens was performed by three gastrointestinal pathologists. Cox proportional hazard analysis was performed to identify independent risk factors associated with metastases. The discriminative ability of this model was assessed using the c-statistic.

    Results 283 patients were included (median age 66 years [IQR: 58-72], 87% male). Endoscopic resection was performed in 100 patients and surgery in 183 patients. Ninety-three (32.9%) patients had metastases, LNM mainly identified in surgical specimens (78/93). In multivariable analysis, the risk of developing metastases increased with worse differentiation grade (G2 vs G1: HR 3.2, 95% CI 1.2-9.0; G3 vs G1: HR 3.1; 95% CI 1.1-8.9), deep submucosal invasion (Sm3: HR 2.4; 95% CI 1.3-4.5) and lymphovascular invasion (HR 3.0; 95% CI 1.9-4.5). The c-statistic of the prediction model was 0.74 (95% CI 0.68-0.79).

    Conclusions One-third of patients with pT1b EAC had metastases. Risk factors are moderate and poor differentiation grade, deep submucosal invasion and the presence of lymphovascular invasion. A personalized risk for LNM can be predicted based on the presence or absence of each of these separate risk factors with a c-statistic of 0.74.


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