Objective: To define prognostic risk factors in patients with early adenocarcinomas of the esophagus (eACEs) who were treated by esophagectomy.
Background: Although endoscopic resection (ER) is more accepted for eACEs limited to the mucosa, the reported prevalence of lymph node metastases once the tumor infiltrates the submucosa seems to necessitate surgery in these cases.
Methods: We analyzed the results of 168 patients who had an esophageal resection because of an eACE. On the basis of specimen histologies and clinical follow-up (median, 64 months), we investigated the influence of lymph node metastases (N+), tumor infiltration depth, tumor differentiation (G1–3), and lymphatic or venous infiltration (L+ or V+) on overall and tumor-specific survival and recurrence rates.
Results: The 5-year survival rate was 79%. Lymph node infiltration was the only prognostic factor for the overall survival [hazard ratio (HR), 2.856; 1.314–6.207; P = 0.008], tumor-specific survival (HR, 8.336; 2.734–25.418; P < 0.001), and tumor recurrence (HR, 8.031; 3.041–21.206; P < 0.001) that was consistently present in all multivariate hazard Cox regression analyses. A total of 47% of the patients who had an N+ status developed tumor recurrences compared with 5.2% of those who had no lymph node involvement (P = <0.001). We found a significant correlation between N+ status and increasing depth of tumor infiltration (P = 0.004), lymphatic vessel infiltration (P = 0.002), tumor differentiation (G1 + G2 vs G3; P = 0.014) and vascular infiltration (P = 0.01).
Conclusions: Lymph node status is the only independent risk factor for survival and recurrence rates. Tumor infiltration depth correlates with the rate of the lymph node metastases, but a clear watershed between deep mucosal and submucosal infiltration does not exist. As a consequence, careful staging procedures, including diagnostic ER, are mandatory to determine which patients can be treated by ER and which require an esophagectomy.
Lymph node infiltration is the only prognostic factor in early adenocarcinomas of the esophagus. The N+ rate depends on histopathologic risk factors and the tumor infiltration depth. As a consequence, careful staging procedures, including a diagnostic endoscopic resection with a meticulous histopathologic workup, are mandatory.
*Departments of Surgery
‡Gastroenterology, Dr Horst-Schmidt-Klinik, Wiesbaden, Germany; and
§Department of Pathology, Klinikum Kulmbach, Germany.
Reprints: Dietmar Lorenz, MD, Department of Surgery, Dr. Horst-Schmidt-Kliniken, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany. E-mail: firstname.lastname@example.org.
Disclosure: The authors declare no conflicts of interest.