Prognostic significance of the T2 substage in patients with esophageal squamous cell carcinoma

Abstract

The invasion of the muscularis propria is defined as T2 stage in esophageal squamous cell carcinoma. Evidence is lacking regarding whether the T2 substage based on anatomy may serve as a prognostic indicator. This study aims to confirm the prognostic value of the T2 substage. The clinicopathological characteristics of 120 patients who had pathologically verified T2 tumors between 2006 and 2011 at the Tianjin Medical University Cancer Institute and Hospital were retrospectively studied. Based on the invasion depth, tumors that had penetrated the circular muscle layer were defined as T2a, while T2b disease referred to those that had invaded the longitudinal muscle layer. Factors potentially related to survival were analyzed with univariate and multivariate analyses. The logistic regression model was used to examine the factors associated with lymph node metastasis. To verify the prognostic value of the T2 substage further, patients with T1b and T3 stage disease during the same period were selected for comparisons. The univariate and multivariate analyses demonstrated that the T2 substage and N stage were independent prognostic factors. The T2 substage was highly relevant to lymph node metastasis in the logistic regression model (P = 0.044). When T1b and T3 was considered, the survival of T2a patients was closer to that of T1b patients, while the survival of T2b patients was closer to that of T3 disease (P = 0.000). The T2 substage was an independent prognostic factor. Patients with T2a tumors displayed a favorable survival, while the prognosis of T2b patients was closer to that of T3 patients.

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

“…Nevertheless, we could not determine whether there were differences in general characteristics between patients with T2 circular and T2 longitudinal ESCC in this study. Similarly, a study of 120 patients by Duan et al [9] also emphasized the poor prognosis of T2 longitudinal patients ( P < 0.001). However, the above studies were single‐center studies with relatively small sample populations, which might have led to inaccurate results.…”

“…With increasing tumor invasion depth, patients with T2 ESCC have a greater risk of LNM, but this finding does not suggest that T2 ESCC should be subclassified. However, the association between LNM and the T2 substage in previous studies was positive, and patients with T2 longitudinal ESCC had a higher incidence of positive lymph nodes than patients with T2 circular ESCC (52.2% vs 30.8%, 37.2% vs 19.0%, P < 0.05) [8, 9]. This apparent difference might be due to the size of the sample population.…”

“…Guo et al [8] retrospectively evaluated the clinicopathological data of 85 patients with T2 ESCC and showed that the T2 substage was an independent prognostic factor for patients. Duan et al [9] performed a similar study to support the hypotheses that T2 ESCC can be subclassified and that T2 circular patients have a superior prognosis. However, another study [10] found that the T2 substage did not correlate with the survival of T2 EC patients.…”

Predicting lymph node metastases with endoscopic resection in cT2N0M0 oesophageal cancer: A systematic review and meta‐analysis

“…Two studies investigated tumour invasion depth into the muscularis propria as risk factor for LNM in pT2 squamous cell carcinoma 38,39 . Depth of invasion into the muscularis propria was classified as invasion into the outer longitudinal versus the inner circular muscle layer.…”

“…Two studies investigated tumour invasion depth into the muscularis propria as risk factor for LNM in pT2 squamous cell carcinoma. 38,39 Depth of invasion into the muscularis propria was classified as invasion into the outer longitudinal versus the inner circular muscle layer. Both Duan et al and Guo et al reported that pT2 tumours invading into the longitudinal layer were at an increased risk for LNM with OR 2.5 (95% CI: 1.0-6.2) and OR 2.5 (95% CI: 1.0-6.0), respectively (Supplementary Material Table 5).…”