Lymphovascular invasion quantification could improve risk prediction of lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma

Abstract

Aim To quantify lymphovascular invasion (LVI) and to assess the prognostic value in patients with pT1b esophageal adenocarcinoma. Methods In this nationwide, retrospective cohort study, patients were included if they were treated with surgery or endoscopic resection for pT1b esophageal adenocarcinoma. Primary endpoint was the presence of metastases, lymph node metastases, or distant metastases, in surgical resection specimens or during follow‐up. A prediction model to identify risk factors for metastases was developed and internally validated. Results 248 patients were included. LVI was distributed as follows: no LVI (n = 196; 79.0%), 1 LVI focus (n = 16; 6.5%), 2–3 LVI foci (n = 21; 8.5%) and ≥4 LVI foci (n = 15; 6.0%). Seventy‐eight patients had metastases. The risk of metastases was increased for tumors with 2–3 LVI foci [subdistribution hazard ratio (SHR) 3.39, 95% confidence interval (CI) 2.10–5.47] and ≥4 LVI foci (SHR 3.81, 95% CI 2.37–6.10). The prediction model demonstrated a good discriminative ability (c‐statistic 0.81). Conclusion The risk of metastases is higher when more LVI foci are present. Quantification of LVI could be useful for a more precise risk estimation of metastases. This model needs to be externally validated before implementation into clinical practice.

Imaging biomarkers to stratify lymph node metastases in abdominal CT – Is radiomics superior to dual-energy material decomposition?

“…The identification of patients with lymph node metastases is decisive and has therapeutic and prognostic relevance [32] , [33] . RECIST criteria give guidance, but follow-up scans may be necessary for diagnosis, potentially causing delayed detection of nodular spread or recurrence of disease.…”

Meta-analysis of the relationship between lymphovascular invasion and prognosis of patients with stage I gastric cancer

“…[4][5][6] At present, several studies in other solid tumors have confirmed that lymphovascular invasion is closely related to the prognosis of many kinds of malignant tumors such as lung cancer, breast cancer, and esophageal cancer. [7][8][9] However, the relationship between lymphovascular invasion and the prognosis of patients with stage I gastric cancer is still controversial. One view is that lymphovascular invasion is an independent prognostic factor in patients with stage I gastric cancer, [10,11] while the other view is just the opposite.…”