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Predicting lymph node metastasis for endoscopic resection of superficial esophageal squamous cell carcinoma

 Dae Won Ma  ;  Da Hyun Jung  ;  Jie-Hyun Kim  ;  Jae Jun Park  ;  Young Hoon Youn  ;  Hyojin Park 
 Journal of Thoracic and Cardiovascular Surgery, Vol.157(1) : 397-402 e1, 2019 
Journal Title
 Journal of Thoracic and Cardiovascular Surgery 
Issue Date
lymph node metastasis ; risk stratification system ; superficial esophageal squamous cell carcinoma
OBJECTIVE: The aims of this study were to identify risk factors for lymph node metastasis and develop a reliable risk stratification system. METHODS: Between May 2001 and December 2015, 262 patients who underwent endoscopic resection or surgery for superficial esophageal squamous cell carcinoma were enrolled. We evaluated possible predictive factors for lymph node metastasis: age, gender, tumor length, tumor area, circumferential spread, tumor location, gross appearance, depth of invasion, tumor differentiation, and lymphovascular invasion. RESULTS: The incidence of lymph node metastasis was 14.5% (38/262). In multivariate analysis, tumor size (>15 mm), depth of invasion (submucosal invasion), and lymphovascular invasion were significantly associated with lymph node metastasis. These factors were included in the risk stratification system and assigned scores; the total risk stratification system score was 0 to 6. The area under the receiver operating characteristic curve for predicting lymph node metastasis was 0.869 (95% confidence interval, 0.813-0.926). The high-risk group (risk stratification system score ≥3) exhibited a significantly higher risk of lymph node metastasis than the low-risk group (score <3) (26.5% vs 1.6%). There was no lymph node metastasis in patients with a risk stratification system of 0. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the risk stratification system were 94.7%, 55.4%, 26.5%, 98.4%, and 61.1%, respectively. CONCLUSIONS: We developed a risk stratification system that should facilitate the identification of patients with a high or low risk of lymph node metastasis. This may aid the precise selection of patients who can undergo endoscopic resection.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Park, Jae Jun(박재준)
Park, Hyo Jin(박효진) ORCID logo https://orcid.org/0000-0003-4814-8330
Youn, Young Hoon(윤영훈) ORCID logo https://orcid.org/0000-0002-0071-229X
Jung, Da Hyun(정다현)
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