Depth of Invasion into the Circular and Longitudinal Muscle Layers in T2 Esophageal Squamous Cell Carcinoma Does Not Affect Prognosis or Lymph Node Metastasis: A Multicenter Retrospective Study

Abstract

Background Although a greater depth of tumor invasion is correlated with a poorer prognosis in esophageal squamous cell carcinoma (ESCC), it remains controversial whether T2 ESCC should be subclassified by circular and longitudinal muscle invasion. We conducted a multicenter retrospective study to evaluate the relationship between the depth of invasion and long‐term outcome and to identify the clinical significance of subclassifying T2 ESCC. Methods Patients with T2 ESCC who underwent esophagectomy at two different institutes between January 2009 and December 2017 were analyzed retrospectively. ESCC with circular and longitudinal muscle invasion was defined as T2 circular and T2 longitudinal ESCC, respectively. Survival outcomes and risk factors for lymph node metastasis (LNM) were evaluated by univariate and multivariate analyses. In addition, data from stage T1b ESCC cases during the same period were retrieved for use as a comparison cohort to evaluate the prognostic significance of the T2 substage. Results A total of 536 T2 ESCC patients were eligible, and 192 (36%) patients developed LNM. No significant difference was found in general characteristics between the T2 circular and T2 longitudinal ESCC groups (n = 219 and n = 317, P > 0.05), except for tumor location (P = 0.02). The T2 substage was not significantly correlated with survival on univariate or multivariate analysis (P = 0.30 and P = 0.34, respectively). Multivariate analysis also indicated that the T2 substage was not an independent risk factor for LNM (P = 0.15). When patients with stage T1b ESCC were considered, their survival time was significantly different from that of patients with T2 circular and T2 longitudinal disease (P = 0.01). Conclusions The depth of tumor invasion into the circular and longitudinal muscle layers in T2 ESCC does not affect the prognosis or risk of LNM.

Machine learning models predict lymph node metastasis in patients with stage T1-T2 esophageal squamous cell carcinoma

“…The rate of LNM differs substantially between different T stages. In this study, the LNM rates of stage T1 and T2 were 16.4% and 36.2%, respectively, which was consistent with the reported incidence ( 10 , 35 , 37 , 44 ). To distinguish the ability of the model to discriminate LNM in patients with T1 and T2 stages, we tested the optimal model on different T stages of the external test set.…”

Impact of deep muscle invasion on nodal status and survival in patients with pT2 esophageal squamous cancer

“…These results were similar to those reported by Duan et al, 7 who also concluded that T2 substage was an independent prognostic factor from a single‐center, small sample size database (120 ESCC). In contrast, Tian et al 8 showed that the T2 substage was not significantly associated with ESCC patient survival in Cox regression analysis. Interestingly, they found that survival time was significantly different among T1b, T2 circular muscle invasion, and T2 longitudinal muscle invasion in ESCC ( p = 0.01).…”

“…23,24 Current evidence on the prognostic value of the T2 substage in ESCC is still scarce and limited to several studies involving small sample sizes. [6][7][8] The strength of our study included the level of evidence, which involved a multicenter, large sample size, and prospectively collected database. Furthermore, neoadjuvant therapy has become the standard treatment for locally advanced esophageal cancer.…”

“…5 Currently, whether T2 ESCC should be subclassified remains unclear. [6][7][8] Guo et al 6 found that the T2 substage was an independent prognostic factor in T2 ESCC. However, Tian et al 8 concluded that the T2 substage in T2 ESCC did not affect patient survival or the risk of lymph node metastasis.…”

“…However, from a pathological standpoint, the esophageal muscularis propria consists of a superficial circular layer and a deep longitudinal layer 5 . Currently, whether T2 ESCC should be subclassified remains unclear 6–8 . Guo et al 6 found that the T2 substage was an independent prognostic factor in T2 ESCC.…”