Individual risk calculator to predict lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma: A multicenter cohort study

Annieke W. Gotink, Steffi E.M. Van De Ven, Fiebo J.C. Ten Kate, Daan Nieboer, Lucia Suzuki, Bas L.A.M. Weusten, Lodewijk A.A. Brosens, Richard Van Hillegersberg, Lorenza Alvarez Herrero, Cees A. Seldenrijk, Alaa Alkhalaf, Freek C.P. Moll, Erik J. Schoon, Ineke Van Lijnschoten, Thjon J. Tang, Hans Van Der Valk, Wouter B. Nagengast, Gursah Kats-Ugurlu, John T.M. Plukker, Martin H.M.G. HoubenJaap S. Van Der Laan, Roos E. Pouw, Jacques J.G.H.M. Bergman, Sybren L. Meijer, Mark I. Van Berge Henegouwen, Bas P.L. Wijnhoven, Pieter Jan F. De Jonge, Michael Doukas, Marco J. Bruno, Katharina Biermann, Arjun D. Koch*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Web of Science)
24 Downloads (Pure)


Background Lymph node metastasis (LNM) is possible after endoscopic resection of early esophageal adenocarcinoma (EAC). This study aimed to develop and internally validate a prediction model that estimates the individual risk of metastases in patients with pT1b EAC.Methods A nationwide, retrospective, multicenter cohort study was conducted in patients with pT1b EAC treated with endoscopic resection and/or surgery between 1989 and 2016. The primary end point was presence of LNM in surgical resection specimens or detection of metastases during follow-up.All resection specimens were histologically reassessed by specialist gastrointestinal pathologists. Subdistribution hazard regression analysis was used to develop the prediction model. The discriminative ability of this model was assessed using the c-statistic.Results 248 patients with pT1b EAC were included. Metastases were seen in 78 patients, and the 5-year cumulative incidence was 30.9% (95% confidence interval [CI] 25.1%-36.8%). The risk of metastases increased with submucosal invasion depth (subdistribution hazard ratio [SHR] 1.08, 95%CI 1.02-1.14, for every increase of 500 mu m), lymphovascular invasion (SHR 2.95, 95%CI 1.95-4.45), and for larger tumors (SHR 1.23, 95%CI 1.10-1.37, for every increase of 10mm). The model demonstrated good discriminative ability (c-statistic 0.81, 95%CI 0.75-0.86).Conclusions A third of patients with pT1b EAC experienced metastases within 5 years. The probability of developing post-resection metastases was estimated with a personalized predicted risk score incorporating tumor invasion depth, tumor size, and lymphovascular invasion. This model requires external validation before implementation into clinical practice.
Original languageEnglish
Pages (from-to)109-117
Number of pages9
Issue number2
Publication statusPublished - Feb 2022

Bibliographical note

Publisher Copyright:
© 2022 Georg Thieme Verlag. All rights reserved.


Dive into the research topics of 'Individual risk calculator to predict lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma: A multicenter cohort study'. Together they form a unique fingerprint.

Cite this