title: Predicting lymph node metastases in early esophageal adenocarcinoma using a simple scoring system.
abstract: BACKGROUND
  Endoscopic resection is an organ-sparing option for early esophageal adenocarcinoma, but should be used only in patients with a negligible risk of lymph node metastases (LNM). The objective was to develop a simple scoring system to predict LNM in T1 esophageal adenocarcinoma.
  
  
  METHODS
  All primary esophagectomies performed for T1 esophageal adenocarcinoma without neoadjuvant therapy at 5 university institutions from 2000 to 2011 were analyzed. Patient and pathologic characteristics were compared between patients with LNM at the time of surgical resection and those without. Univariate and multivariate analyses were performed to establish a simple scoring system that estimated the risk of LNM, using variables from the final surgical pathology.
  
  
  RESULTS
  A total of 258 patients were included for analysis (mean age 65.2 years [SD 10.3 years], 88% male). The incidence of LNM was 7% (9 of 122) for T1a and 26% (35 of 136) for T1b. Tumor size (odds ratio [OR] 1.35 per cm, 95% CI 1.07 to 1.71) and lymphovascular invasion (OR 7.50, 95% CI 3.30 to 17.07) were the strongest independent predictors of LNM. A weighted scoring system was devised from the final multivariate model and included size (+1 point per cm), depth of invasion (+2 for T1b), differentiation (+3 for each step of dedifferentiation), and lymphovascular invasion (+6 if present). Total number of points estimated the probability of LNM (low risk [0 to 1 point], ≤ 2%; moderate risk [2 to 4 points], 3% to 6%; and high risk [5+ points], ≥ 7%).
  
  
  CONCLUSIONS
  We devised a simple scoring system that accurately estimates the risk of LNM to aid in decision-making in patients with T1 esophageal adenocarcinoma undergoing endoscopic resection.
authors: Division of Thoracic Surgery, McGill University Health Centre, Montreal, Canada.
authors: Lawrence
authors: L
authors: Lee
authors: Ulrich
authors: U
authors: Ronellenfitsch
authors: Wayne L
authors: WL
authors: Hofstetter
authors: Gail
authors: G
authors: Darling
authors: Timo
authors: T
authors: Gaiser
authors: Christiane
authors: C
authors: Lippert
authors: Sebastien
authors: S
authors: Gilbert
authors: Andrew J
authors: AJ
authors: Seely
authors: David S
authors: DS
authors: Mulder
authors: Lorenzo E
authors: LE
authors: Ferri
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D003661:Decision Support Techniques; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: AJCC; American Joint Committee on Cancer; IQR; LN; LVI; OR; interquartile range; lymph node; lymphovascular invasion; odds ratio