Treatment allocation in patients with early-stage esophageal adenocarcinoma: Prevalence and predictors of lymph node involvement.

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  • معلومة اضافية
    • Author-Supplied Keywords:
      Barrett esophagus
      early esophageal cancer
      endoscopic mucosal surgical resection
      esophageal adenocarcinoma
      esophageal cancer
    • Abstract:
      Background: In considering treatment allocation for patients with early esophageal adenocarcinoma, the incidence of lymph node metastasis is a critical determinant; however, this has not been well defined or stratified by the relevant clinical predictors of lymph node spread.Methods: Data from the Surveillance, Epidemiology, and End Results database of the National Cancer Institute were abstracted from 2004 to 2010 for patients with early-stage esophageal adenocarcinoma. The incidence of lymph node involvement for patients with Tis, T1a, and T1b tumors was examined and was stratified by predictors of spread.Results: A total of 13,996 patients with esophageal adenocarcinoma were evaluated. Excluding those with advanced, metastatic, and/or invasive (T2-T4) disease, 715 patients with Tis, T1a, and T1b tumors were included. On multivariate analysis, tumor grade (odds ratio [OR], 2.76; 95% confidence interval [95% CI], 1.58-4.82 [P<.001]), T classification (OR, 0.47; 95% CI, 0.24-0.91 [P =.025]), and tumor size (OR, 2.68; 95% CI, 1.48-4.85 [P = .001]) were found to be independently associated with lymph node metastases. There was no lymph node spread noted with Tis tumors. For patients with low-grade (well or moderately differentiated) tumors measuring <2 cm in size, the risk of lymph node metastasis was 1.7% for T1a (P<.001) and 8.6% for T1b (P = .001) tumors.Conclusions: For patients with low-grade Tis or T1 tumors measuring ≤2 cm in size, the incidence of lymph node metastasis appears to be comparable to the mortality rate associated with esophagectomy. For highly selected patients with early esophageal adenocarcinomas, the results of the current study support the recommendation that local endoscopic resection can be considered as an alternative to surgical management when followed by rigorous endoscopic and radiographic surveillance. Cancer 2016;122:2150-7. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]
    • Abstract:
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    • Author Affiliations:
      1Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta Georgia
      2Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta Georgia
      3Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta Georgia
      4Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta Georgia
      5Interventional Endoscopy, Gastroenterology and Nutrition, Cancer Treatment Centers of America, Newnan Georgia
      6Department of Medicine, Emory University School of Medicine, Atlanta Georgia
      7Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta Georgia
    • ISSN:
      0008-543X
    • Accession Number:
      10.1002/cncr.30040
    • Accession Number:
      116751204
  • Citations
    • ABNT:
      GAMBOA, A. M. et al. Treatment allocation in patients with early-stage esophageal adenocarcinoma: Prevalence and predictors of lymph node involvement. Cancer (0008543X), [s. l.], v. 122, n. 14, p. 2150–2157, 2016. DOI 10.1002/cncr.30040. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=116751204&custid=s8280428. Acesso em: 11 dez. 2019.
    • AMA:
      Gamboa AM, Kim S, Force SD, et al. Treatment allocation in patients with early-stage esophageal adenocarcinoma: Prevalence and predictors of lymph node involvement. Cancer (0008543X). 2016;122(14):2150-2157. doi:10.1002/cncr.30040.
    • APA:
      Gamboa, A. M., Kim, S., Force, S. D., Staley, C. A., Woods, K. E., Kooby, D. A., … Willingham, F. F. (2016). Treatment allocation in patients with early-stage esophageal adenocarcinoma: Prevalence and predictors of lymph node involvement. Cancer (0008543X), 122(14), 2150–2157. https://doi.org/10.1002/cncr.30040
    • Chicago/Turabian: Author-Date:
      Gamboa, Anthony M., Sungjin Kim, Seth D. Force, Charles A. Staley, Kevin E. Woods, David A. Kooby, Shishir K. Maithel, et al. 2016. “Treatment Allocation in Patients with Early-Stage Esophageal Adenocarcinoma: Prevalence and Predictors of Lymph Node Involvement.” Cancer (0008543X) 122 (14): 2150–57. doi:10.1002/cncr.30040.
    • Harvard:
      Gamboa, A. M. et al. (2016) ‘Treatment allocation in patients with early-stage esophageal adenocarcinoma: Prevalence and predictors of lymph node involvement’, Cancer (0008543X), 122(14), pp. 2150–2157. doi: 10.1002/cncr.30040.
    • Harvard: Australian:
      Gamboa, AM, Kim, S, Force, SD, Staley, CA, Woods, KE, Kooby, DA, Maithel, SK, Luke, JA, Shaffer, KM, Dacha, S, Saba, NF, Keilin, SA, Cai, Q, El, RBF, Chen, Z & Willingham, FF 2016, ‘Treatment allocation in patients with early-stage esophageal adenocarcinoma: Prevalence and predictors of lymph node involvement’, Cancer (0008543X), vol. 122, no. 14, pp. 2150–2157, viewed 11 December 2019, .
    • MLA:
      Gamboa, Anthony M., et al. “Treatment Allocation in Patients with Early-Stage Esophageal Adenocarcinoma: Prevalence and Predictors of Lymph Node Involvement.” Cancer (0008543X), vol. 122, no. 14, July 2016, pp. 2150–2157. EBSCOhost, doi:10.1002/cncr.30040.
    • Chicago/Turabian: Humanities:
      Gamboa, Anthony M., Sungjin Kim, Seth D. Force, Charles A. Staley, Kevin E. Woods, David A. Kooby, Shishir K. Maithel, et al. “Treatment Allocation in Patients with Early-Stage Esophageal Adenocarcinoma: Prevalence and Predictors of Lymph Node Involvement.” Cancer (0008543X) 122, no. 14 (July 15, 2016): 2150–57. doi:10.1002/cncr.30040.
    • Vancouver/ICMJE:
      Gamboa AM, Kim S, Force SD, Staley CA, Woods KE, Kooby DA, et al. Treatment allocation in patients with early-stage esophageal adenocarcinoma: Prevalence and predictors of lymph node involvement. Cancer (0008543X) [Internet]. 2016 Jul 15 [cited 2019 Dec 11];122(14):2150–7. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=116751204&custid=s8280428