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The Overall Prevalence of Metastasis in T1 Esophageal Squamous Cell Carcinoma: A Retrospective Analysis of 295 Patients

Akutsu, Yasunori MD, PhD; Uesato, Masaya MD, PhD; Shuto, Kiyohiko MD, PhD; Kono, Tsuguaki MD, PhD; Hoshino, Isamu MD, PhD; Horibe, Daisuke MD, PhD; Sazuka, Testutaro MD, PhD; Takeshita, Nobuyoshi MD; Maruyama, Tetsuro MD; Isozaki, Yuka MD; Akanuma, Naoki MD; Matsubara, Hisahiro MD, PhD

doi: 10.1097/SLA.0b013e31827017fc
Original Articles

Objectives: T1 esophageal squamous cell carcinoma (ESCC) has a low, but still present, risk of lymph node (LN) metastasis. Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is often applied for T1 ESCC. To achieve successful treatment by EMR/ESD, the risk of LN metastases, LN recurrence, and hematological recurrence need to be better understood. The aim of this study was to determine the precise risk for metastasis in T1 ESCC.

Methods: We divided 295 patients with T1 ESCC who underwent surgery and/or ESD/EMR into 6 categories (m1, m2, m3, sm1, sm2, and sm3). Their risks of LN metastasis, LN recurrence, hematological recurrence, and the outcome were determined.

Results: The rates of LN metastasis and LN recurrence were 0% in m1 and m2, 9% in m3, 16% in sm1, 35% in sm2, and 62% in sm3 cases. The incidence of hematological recurrence was 0% in m1, m2, m3, and sm1 cases; 9% in sm2 cases; and 13% in sm3 cases. The overall risk of metastasis was 9% in m3, 16% in sm1, 38% in sm2, and 64% in sm3 patients. The 5-year disease-specific survival rates were 100% in m1, m2, and m3; 90.9% in sm1; 78.8% in sm2; and 68.6% in sm3 patients. Statistically, both lymphatic and venous invasion were selected as predictive markers for metastasis. In m3 patients, positivity for either of these had an odds ratio for metastasis of 7.333 (P = 0.093).

Conclusions: Our study provides a precise assessment of the comprehensive risk of metastasis and feasible predictive markers for T1 ESCC.

Supplemental Digital Content is Available in the Text.This study retrospectively reviewed 259 patients with T1 esophageal squamous cell carcinoma treated with surgery or endoscopic therapy to evaluate the risks of pathological lymph node metastasis, lymph node recurrence, and hematological recurrence. Thereafter, the validation of all statistically selected risk factors for the prediction of risk was performed.

Department of Frontier Surgery, Graduate School of Medicine, Chiba University.

Reprints: Yasunori Akutsu, MD, PhD, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan. E-mail:

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Disclosure: The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.