Lymphovascular invasion as a tool to further subclassify T1b esophageal adenocarcinoma

Abstract

BACKGROUND.Lymphovascular invasion (LVI) and/or lymph node metastases (LNM) adversely influence the overall survival (OS) of patients with T1 esophageal adenocarcinoma. Although endoscopic therapy may be adequate for patients with T1a cancer, patients with T1b cancer require esophagectomy/lymphadenectomy. The authors hypothesized that LVI status would subclassify T1b cancers and facilitate new therapeutic strategies.METHODS.Ninety‐nine consecutive patients with T1 adenocarcinoma were analyzed after they underwent esophagectomy/lymphadenectomy. LNM was assessed in all patients, and LVI was assessed in 89 patients. OS was correlated with pathologic cancer stage in association with LVI and LNM.RESULTS.The 5‐year OS rate for patients with T1a tumors (88%) was superior to that for patients with T1b tumors (62%; P = .001). The 5‐year OS rate for patients who had cancers without LVI (85%) was superior to the rate for patients who had cancers with LVI (36%; P = .0001). It is noteworthy that, for cancers without LVI, the 5‐year OS rate for patients with T1b tumors (77%) was similar to the rate for patients with T1a tumors (90%; P = .08), but it was superior to the rate for patients with T1b tumors that had LVI (27%; P = .006). The presence of LVI and/or LNM resulted in worse 5‐year OS (≤37%) compared with the lack of LVI and/or LNM (88%; P < .001). The rate of LNM for patients who had T1b tumors without LVI still was 19%, and the relapse rate was 16%.CONCLUSIONS.The current results demonstrated that LVI distinguishes the biologic behavior of early esophageal cancer, and patients who have T1b cancer without LVI have a clinical biology similar to that of patients with T1a cancer. If LNM before surgery can be diagnosed with high sensitivity by better endoscopic techniques and/or molecular biomarkers, then a new therapeutic paradigm for T1b cancers could emerge. Further research is needed on patients with T1b esophageal adenocarcinoma. Cancer 2008. © 2008 American Cancer Society.

Duplicated Muscularis Mucosae Invasion has Similar Risk of Lymph Node Metastasis and Recurrence-free Survival as Intramucosal Esophageal Adenocarcinoma

“…In addition, findings in this study also support those of previous studies 4,22 showing that lymphovascular invasion is the best pathologic predictor of lymph node status and patient outcome in pT1 EAC.…”

Prognostic Impact of Upper, Middle, and Lower Third Mucosal or Submucosal Infiltration in Early Esophageal Cancer

“…21,22 In contrast, lymphadenectomy does not seem be important for patients with mucosal cancer as none in the authors' series has had LNM and the literature reports LNM in only 2% to 3% of patients with mucosal cancer (Table 5). [8][9][10][11][12][23][24][25][26][27][28][29][30][31][32] This represents a slight difference to early gastric cancer, which shows LNM of m3 in 13%. 33 Consequently, the prognosis of patients with mucosal esophageal cancer may not be improved by radical esophagectomy and lymphadenectomy compared with either standard esophagectomy or even endoscopic removal of the lesion.…”

Complex General Surgical Oncology: A Case-Based Approach - Volume 1

“…Finally, it is worth noting that these practices apply only to 'pure' ADH. If additional, more aggressive disease is associated with ADH, treatment should be based on the more advanced diagnosis [8][9][10][11][12][13][14][15][16].…”