Multifocal neoplasia and nodal metastases in T1 esophageal carcinoma - Implications for endoscopic treatment
Multifocal neoplasia and nodal metastases in T1 esophageal carcinoma - Implications for endoscopic treatment
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DOI：
10.1097/sla.0b013e318163a2ff
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发表时间：
2008-03-01
影响因子：
9
通讯作者：
Port, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Altorki, Nasser K.;Lee, Paul C.;Port, Jeffrey L.
目的：粘膜内（T1 a）或粘膜下（T1 b）食管癌的内镜治疗（ET）越来越受到关注。本研究的目的是确定淋巴结转移，淋巴管浸润，多灶性肿瘤的患病率与pT 1食管癌患者进行食管切除术前治疗，并评估其潜在的影响ET。方法：我们回顾性分析了所有患者进行食管切除术前治疗pT 1食管癌的记录。对所有的病理报告进行了详细的回顾，以确定相关的病理标准，包括浸润深度（T1 a或T1 b），细胞类型（腺癌/鳞状），肿瘤分化（差vs.良好/中度），Barrett食管程度（短段[SSBE]和长段[LSBE]），淋巴结状态，淋巴管浸润（LVI），以及多灶性瘤形成（MFN）（高度异型增生或浸润性癌）的存在。总生存率和疾病特异性生存率由Kaplan-Meier方法确定。结果：1994年1月至2006年9月期间共有75例连续患者（58例男性，17例女性）。中位年龄为68岁。住院死亡率为2.6%（2/75）。30例患者患有T1 a，45例患有T1 b。60例患者患有腺癌。30例T1 a肿瘤中有2例（6%）出现淋巴结转移，45例T1 b肿瘤中有8例（17.5%）出现淋巴结转移。T1 a期肿瘤中MFN阳性率为30%（9/30），T1 b期肿瘤中MFN阳性率为29%（13/45）。所有9例LVI患者均为T1 b肿瘤。总的来说，10/30例（33.3%）T1 a患者和25/45例（58%）T1 b患者有MFN、LVI或淋巴结转移。49例患者患有腺癌伴BE（23例SSBE，26例LSBE）。SSBE患者和LSBE患者之间的淋巴结疾病发生率无差异（2/23 vs. 2/26），但MFN发生率有显著差异（3/23 vs. 13/26，P = 0.006）。4例鳞状细胞癌有淋巴结转移，5例有MFN。总体5年生存率为78%（T1 a-90%T1b：71%，P = 0.07）。5年疾病特异性生存率为86.5%（T1 a：96.7%，T1 b：79.6%，P = 0.06）。结论：合并MFN，LVI和隐匿性淋巴结转移的高发生率不支持使用ET治疗T1食管癌患者，无论浸润深度，细胞类型，分化或BE程度如何。ET可能是有价值的患者在手术风险被认为是禁止的。
Objective: There has been an increase in interest in endoscopic therapy (ET) for intramucosal (T1a) or submucosal (T1b) esophageal carcinoma. The objective of the present study was to determine the prevalence of nodal metastases, lymphatic vascular invasion, and multifocal neoplasia in patients with pT1 esophageal carcinoma who underwent esophagectomy without preoperative therapy and assess their potential implication for ET.Methods: We retrospectively reviewed the records of all patients who underwent esophagectomy without preoperative therapy for pT1 esophageal cancer. A detailed review of all pathology reports was performed to identify relevant pathologic criteria including depth of invasion (T1a or T1b), cell type (adenocarcinoma/squamous), tumor differentiation (poor vs. well/moderate), extent of Barrett esophagus (short segment [SSBE] and long segment [LSBE]), nodal status, lymphovascular invasion (LVI), and the presence of multifocal neoplasia (MFN)(high-grade dysplasia or invasive carcinoma). Overall survival and disease- specific survival were determined by the Kaplan-Meier method.Results: There were 75 consecutive patients (58 men, 17 women) between January 1994 and September 2006. Median age was 68 years. Hospital mortality was 2.6% (2 of 75). Thirty patients had T I a and 45 had T1b. Sixty patients had adenocarcinoma. Nodal metastases were present in 2 of 30 (6%) T1a and 8 of 45 (17.5%) T1b tumors. MFN was present in 30% (9 of 30) of T I a tumors and 29% (13 of 45) of T1b tumors. All 9 patients with LVI had T1b tumors. Collectively, 10 of 30 (33.3%) patients with T1a and 25 of 45 (58%) with T1b had MFN, LVI, or nodal metastases. Forty-nine patients had adenocarcinoma with associated BE (23 SSBE, 26 LSBE). There was no difference between patients with SSBE and those with LSBE in the incidence of nodal disease (2 of 23 vs. 2 of 26) but a significant difference in the incidence of MFN (3 of 23 vs. 13 of 26, P = 0.006). Four patients with squamous carcinoma had nodal metastases and 5 had MFN. Overall 5-year survival was 78% (T1a-90% T1b: 71%, P = 0.07). Five-year disease-specific survival was 86.5% (T1a: 96.7%, T1b: 79.6%, P = 0.06).Conclusion: The combined high incidence of MFN, LVI, and occult nodal metastases does not support the use of ET in patients with T1 esophageal cancer regardless of depth of invasion, cell type, differentiation or extent of BE. ET may be of value in patients in whom surgical risk is considered prohibitive.