Meta-analysis of lymph node metastasis in Siewert type Ⅰ and Ⅱ T1 adenocarcinomas

作     者：Hiroki Osumi Junko Fujisaki Masami Omae Tomoki Shimizu Toshiyuki Yoshio Akiyoshi Ishiyama Toshiaki Hirasawa Tomohiro Tsuchida Yorimasa Yamamoto Hiroshi Kawachi Noriko Yamamoto Masahiro Igarashi 

作者机构：Departments of Gastroenterology and Pathology Cancer Institute Hospital Japanese Foundation for Cancer Research Departments of Pathology Cancer Institute Hospital Japanese Foundation for Cancer Research 

出 版 物：《World Journal of Meta-Analysis》 (世界荟萃分析杂志)

年 卷 期：2016年第4卷第6期

页      面：118-123页

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 10[医学] 

主　　题：Siewert type Ⅰ and type Ⅱ adenocarcinomas Lymph node metastasis 

摘      要：AIM To evaluate the incidence of lymph node metastasis(LNM) and its risk factors in patients with Siewert type Ⅰ and type Ⅱ pT1 adenocarcinomas.METHODS We enrolled 85 patients [69 men, 16 women; median age(range), 67(38-84) years] who had undergone esophagectomy or proximal gastrectomy for Siewert type Ⅰ and type Ⅱ pT1 adenocarcinomas. Predictive risk factors of LNM included age, sex, location of the tumor center, confirmed Barrett s esophageal adenocarcinoma, tumor size, macroscopic tumor type, pathology, invasion depth, presence of ulceration, and lymphovascular invasion. Multivariate logistic regression analysis was used to identify factors predicting LNM. We also evaluated the frequencies of LNM for Siewert type Ⅰ and type Ⅱ pT1 adenocarcinomas in meta-data analysis.RESULTS LNMs were found in 11 out of 85 patients(12.9%, 95%CI: 5.8-20.0). Only 1 of the 15 patients(6.6%, 95%CI: 0.0-19.2) who had a final diagnosis of pT1a adenocarcinoma had a positive LNM, whereas 10 ofthe 70 patients(14.2%, 95%CI: 6.0-22.4) with a final diagnosis of pT1b adenocarcinoma had positive LNM. Furthermore, only one of the 30 patients(3.3%, 95%CI: 0.0-9.7) with a tumor invasion depth within 500 μm from muscularis mucosae had positive LNM. Poor differentiation and lymphovascular invasion were independently associated with a risk of LNM. In meta-data analysis, 12 of the 355 patients(3.3%, 95%CI: 1.5-5.2) who had a final diagnosis of pT1a adenocarcinoma had a positive LNM, whereas 91 of the 438 patients(20.7%, 95%CI: 16.9-24.5) with a final diagnosis of pT1b adenocarcinoma had positive LNM. CONCLUSION We consider endoscopic submucosal dissection(ESD) is suitable for patients with Siewert type Ⅰ and type Ⅱ T1 a adenocarcinomas. For patients with T1b adenocarcinoma, especially invasion depth is within 500 μm from muscularis mucosae with no other risk factor for LNM, diagnostic ESD could be a treatment option according to the overall status of patients and the presence of comorbidities.