OBJECTIVE The aim of this study was to quantify LNM risk and outcomes following treatment of early esophago-gastric (EG) adenocarcinoma. BACKGROUND The standard of care for early T1N0 EG cancer is endoscopic resection (ER). Radical surgical resection is recommended for patients perceived to be at risk of lymph node metastasis (LNM). Current models to select organ-preserving vs. surgical treatment are inconsistent. METHODS CONGRESS is a UK-based multicentre retrospective cohort study. Patients diagnosed with clinical or pathological T1N0 EG adenocarcinoma from 2015-2022 were included. Outcomes and rates of LNM were assessed. Cox regression was performed to assess the impact of prognostic and treatment factors on overall survival. RESULTS 1,601 patients from 26 centres were included, with median follow-up 32 months(IQR 14-53). 1285/1612(80.3%) underwent ER, 497/1601(31.0%) underwent surgery. Overall rate of LNM was 13.5%. On ER staging, tumour depth (T1bsm2-3 17.6% vs. T1a 7.1%), lymphovascular invasion (17.2% vs. 12.6%), or signet cells (28.6% vs. 13.0%) were associated with LNM. In multivariable regression analysis, these were not significantly associated with LNM rates or survival. Adjusting for demographic and tumour variables, surgery after ER was associated with significant survival benefit, HR 0.33(0.15-0.77),P=0.010. CONCLUSION This large multicentre dataset suggests that early EG adenocarcinoma is associated with significant risk of LNM. This data is representative of current real clinical practice with ER-based staging, and suggests previously held beliefs regarding reliability of predictive factors for LNM may need to be reconsidered. Further research to identify patients who may benefit from organ-preserving vs. surgical treatment is urgently required.

中文翻译：

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早期食管胃腺癌恶性淋巴结受累的患病率和危险因素：多中心回顾性大会研究的结果（早期食管胃癌的内镜切除术、食管切除术或胃切除术）。


目的 本研究的目的是量化早期食管胃 (EG) 腺癌治疗后的 LNM 风险和结果。背景 早期 T1N0 EG 癌症的标准治疗是内镜切除 (ER)。对于被认为有淋巴结转移（LNM）风险的患者，建议进行根治性手术切除。目前选择器官保留与手术治疗的模型并不一致。 METHODS CONGRESS 是一项位于英国的多中心回顾性队列研究。 2015 年至 2022 年诊断为临床或病理 T1N0 EG 腺癌的患者包括在内。对 LNM 的结果和发生率进行了评估。进行 Cox 回归来评估预后和治疗因素对总生存期的影响。结果 纳入来自 26 个中心的 1,601 名患者，中位随访时间为 32 个月（IQR 14-53）。 1285/1612（80.3%）接受了ER，497/1601（31.0%）接受了手术。 LNM 总体率为 13.5%。在 ER 分期中，肿瘤深度（T1bsm2-3 17.6% vs. T1a 7.1%）、淋巴管侵犯（17.2% vs. 12.6%）或印戒细胞（28.6% vs. 13.0%）与 LNM 相关。在多变量回归分析中，这些与 LNM 率或生存率没有显着相关。调整人口和肿瘤变量后，ER 后手术与显着的生存获益相关，HR 0.33（0.15-0.77），P=0.010。结论 这个大型多中心数据集表明早期 EG 腺癌与 LNM 的显着风险相关。该数据代表了当前基于 ER 分期的真实临床实践，并表明之前对 LNM 预测因素可靠性的看法可能需要重新考虑。迫切需要进一步的研究来确定哪些患者可以从保留器官与手术治疗中受益。