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

SEM van de Ven; AW Gotink; FJC Ten Kate; D Nieboer; BLAM Weusten; LAA Brosens; R van Hillegersberg; LA Herrero; CA Seldenrijk; A Alkhalaf; FCP Moll; EJ Schoon; I van Lijnschoten; T Tang; H van der Valk; WB Nagengast; G Kats-Ugurlu; JTM Plukker; MHMG Houben; J van der Laan; RE Pouw; JJGHM Bergman; SL Meijer; MI van Berge Henegouwen; BPL Wijnhoven; PJF de Jonge; M Doukas; MJ Bruno; K Biermann; AD Koch

doi:10.1055/s-0040-1704392

Endoscopy, Table of Contents

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

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

SEM van de Ven

¹Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands

,

AW Gotink

¹Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands

,

FJC Ten Kate

²Erasmus Medical Center, Pathology, Rotterdam, Netherlands

,

D Nieboer

³Erasmus Medical Center, Public Health, Rotterdam, Netherlands

,

BLAM Weusten

⁴University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands

,

LAA Brosens

⁵University Medical Center Utrecht, Pathology, Utrecht, Netherlands

,

R van Hillegersberg

⁶University Medical Center Utrecht, Surgery, Utrecht, Netherlands

,

LA Herrero

⁷Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands

,

CA Seldenrijk

⁸Antonius Hospital, Pathology, Nieuwegein, Netherlands

,

A Alkhalaf

⁹Isala Hospital, Gastroenterology and Hepatology, Zwolle, Netherlands

,

FCP Moll

¹⁰Isala Hospital, Pathology, Zwolle, Netherlands

,

EJ Schoon

¹¹Catharina Hospital, Gastroenterology and Hepatology, Eindhoven, Netherlands

,

I van Lijnschoten

¹²Catharina Hospital, Pathology, Eindhoven, Netherlands

,

T Tang

¹³Ijselland Hospital, Gastroenterology and Hepatology, Capelle aan den Ijssel, Netherlands

,

H van der Valk

¹⁴Ijselland Hospital, Pathology, Capelle aan den Ijssel, Netherlands

,

WB Nagengast

¹⁵University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, Netherlands

,

G Kats-Ugurlu

¹⁶University Medical Center Groningen, Pathology, Groningen, Netherlands

,

JTM Plukker

¹⁷University Medical Center Groningen, Surgery, Groningen, Netherlands

,

MHMG Houben

¹⁸Haga Hospital, Gastroenterology and Hepatology, Den Haag, Netherlands

,

J van der Laan

¹⁹Haga Hospital, Pathology, Den Haag, Netherlands

,

RE Pouw

²⁰Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands

,

JJGHM Bergman

²⁰Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands

,

SL Meijer

²¹Amsterdam UMC, Pathology, Amsterdam, Netherlands

,

MI van Berge Henegouwen

²²Amsterdam UMC, Surgery, Amsterdam, Netherlands

,

BPL Wijnhoven

²³Erasmus Medical Center, Surgery, Rotterdam, Netherlands

,

PJF de Jonge

¹Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands

,

M Doukas

²Erasmus Medical Center, Pathology, Rotterdam, Netherlands

,

MJ Bruno

¹Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands

,

K Biermann

²Erasmus Medical Center, Pathology, Rotterdam, Netherlands

,

AD Koch

¹Erasmus MC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands

› Author Affiliations

Abstract

Full Text

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.