Risk Stratification for Early Esophageal Adenocarcinoma: Analysis of Lymphatic Spread and Prognostic Factors

被引:84
作者
Barbour, Andrew P. [1 ]
Jones, Mark [2 ]
Brown, Ian [3 ]
Gotley, David C. [1 ]
Martin, Ian [4 ]
Thomas, Janine [4 ]
Clouston, Andrew [5 ]
Smithers, B. Mark [1 ]
机构
[1] Univ Queensland, Div Surg, Brisbane, Qld, Australia
[2] Princess Alexandra Hosp, Dept Biostat, Brisbane, Qld 4102, Australia
[3] Royal Brisbane Hosp, Dept Pathol, Brisbane, Qld 4029, Australia
[4] Princess Alexandra Hosp, Dept Surg, Brisbane, Qld 4102, Australia
[5] Princess Alexandra Hosp, Dept Pathol, Brisbane, Qld 4102, Australia
关键词
HIGH-GRADE DYSPLASIA; ENDOSCOPIC MUCOSAL RESECTION; LONG-TERM SURVIVAL; BARRETTS-ESOPHAGUS; NODE METASTASIS; PHOTODYNAMIC THERAPY; MUSCULARIS MUCOSAE; SQUAMOUS-CELL; GASTROESOPHAGEAL JUNCTION; INTRAEPITHELIAL NEOPLASIA;
D O I
10.1245/s10434-010-1025-0
中图分类号
R73 [肿瘤学];
学科分类号
100214 [肿瘤学];
摘要
Background. Knowledge of factors related to outcome is vital for the selection of therapeutic alternatives for patients with early (T1) esophageal adenocarcinoma. This study was undertaken to determine predictors of lymphatic spread and prognostic factors for T1 esophageal adenocarcinoma following esophagectomy. Materials and Methods. A prospectively maintained database identified 85 patients with T1 esophageal adenocarcinoma who underwent esophagectomy without neoadjuvant therapy. Depth of tumor invasion (T stage) was subdivided into mucosa] (T I a) or submucosal invasion (T1b). Median follow-up was 59 months. Results. Thoracoscopically assisted 3-phase esophagectomy was performed in 73 of 85 patients (86%). Lymph node metastases (N stage) were identified in 9 of 85 patients (11%). Depth of tumor invasion (T stage), lymphovascular invasion (LVI), and poor differentiation were associated with N stage. The patients could be stratified into 4 risk groups for lymph node metastases: group I-T1a (0 of 35 patients [0%] with positive nodes); group II-T1b, well/moderate differentiation and no LVI (I of 28 patients [4%] with positive nodes); group III-T1b, poor differentiation and no LVI (2 of 9 patients [22%] with positive nodes); and group IV-T1b any grade with LVI (6 of 13 patients [46%] with positive nodes). Survival analyses found T stage, N stage, LVI, and poor differentiation to be significant prognostic factors. Conclusions. Risk stratification is possible for patents with T1 esophageal adenocarcinoma. Local resection techniques without lymphadenectomy may be alternatives for T1a tumors. Esophagectomy should remain the standard of care for patients with T1b tumors and those with LVI or poor differentiation considered for neoadjuvant therapy.
引用
收藏
页码:2494 / 2502
页数:9
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