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01-02-2014 | 2013 SSAT Plenary Presentation

Depth of Submucosal Tumor Infiltration and its Relevance in Lymphatic Metastasis Formation for T1b Squamous Cell and Adenocarcinomas of the Esophagus

Authors: Michael F. Nentwich, Katharina von Loga, Matthias Reeh, Faik G. Uzunoglu, Andreas Marx, Jakob R. Izbicki, Dean Bogoevski

Published in: Journal of Gastrointestinal Surgery | Issue 2/2014

Abstract

Background

Surgery for early esophageal carcinoma has been challenged by less invasive endoscopic approaches. Selecting patients in need for surgical intervention according to their risk of lymphatic spread is mandatory.

Objective

The aim of this study was to evaluate risk factors for lymphatic metastasis formation in T1b esophageal carcinomas.

Methods

Histopathological specimens following surgical resection for T1b esophageal carcinomas were reevaluated for overall submucosal layer thickness, depth of submucosal tumor infiltration, tumor length as well as lymphatic and vascular infiltration. Depth of tumor infiltration to overall submucosal thickness was divided in thirds (SM1, SM2, and SM3) and factors influencing lymphatic metastasis formation were assessed.

Results

A total of 67 patients with pT1b tumors were analyzed, including 36 adenocarcinomas (53.7 %) and 31 squamous cell carcinomas (46.3 %). Lymph node involvement was seen in 22.4 % (15/67) patients without significant differences between SM1 3/11 (27.3 %), SM2, 4/18 (22.2 %), and SM3 (8/38) (21.8 %) (p = 0.909) carcinomas. On binomial log-regression models, only lymphangioinvasion and tumor length >2 cm was significantly associated with lymph node involvement.

Conclusion

As depth of submucosal tumor infiltration did not correlate with the formation of lymph node metastases and in regard of the risk of lymphatic spread in these cases, surgical resection is warranted in pT1b carcinomas.

van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012; 366: 2074–2084PubMedCrossRef

Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, Nachbar L, Huijsmans J, Vieth M, Stolte M. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer). Gastrointest Endosc 2007; 65: 3–10PubMedCrossRef

Pech O, Behrens A, May A, Nachbar L, Gossner L, Rabenstein T, Manner H, Guenter E, Huijsmans J, Vieth M, Stolte M, Ell C. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's oesophagus. Gut 2008; 57: 1200–1206PubMedCrossRef

Boshier PR, Anderson O, Hanna GB. Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer: a meta-analysis. Ann Surg 2011; 254: 894–906PubMedCrossRef

Holscher AH, Bollschweiler E, Bumm R, Bartels H, Hofler H, Siewert JR. Prognostic factors of resected adenocarcinoma of the esophagus. Surgery 1995; 118: 845–855PubMedCrossRef

Bogoevski D, Bockhorn M, Koenig A, Reeh M, von Loga K, Sauter G, Rosch T, Izbicki JR. How radical should surgery be for early esophageal cancer? World J Surg 2011; 35: 1311–1320PubMedCrossRef

Sobin LH, Gospodarowicz MK, Wittekind C TNM Classification of malignant tumours, Wiley, 2011

Rice TW, Zuccaro G, Jr., Adelstein DJ, Rybicki LA, Blackstone EH, Goldblum JR. Esophageal carcinoma: depth of tumor invasion is predictive of regional lymph node status. Ann Thorac Surg 1998; 65: 787–792PubMedCrossRef

Kutup A, Link BC, Schurr PG, Strate T, Kaifi JT, Bubenheim M, Seewald S, Yekebas EF, Soehendra N, Izbicki JR. Quality control of endoscopic ultrasound in preoperative staging of esophageal cancer. Endoscopy 2007; 39: 715–719PubMedCrossRef

10.

Nigro JJ, Hagen JA, DeMeester TR, DeMeester SR, Peters JH, Oberg S, Theisen J, Kiyabu M, Crookes PF, Bremner CG. Prevalence and location of nodal metastases in distal esophageal adenocarcinoma confined to the wall: implications for therapy. J Thorac Cardiovasc Surg 1999; 117: 16–23; discussion 23–15PubMedCrossRef

11.

van Sandick JW, van Lanschot JJ, ten Kate FJ, Offerhaus GJ, Fockens P, Tytgat GN, Obertop H. Pathology of early invasive adenocarcinoma of the esophagus or esophagogastric junction: implications for therapeutic decision making. Cancer 2000; 88: 2429–2437PubMedCrossRef

12.

Stein HJ, Feith M, Mueller J, Werner M, Siewert JR. Limited resection for early adenocarcinoma in Barrett's esophagus. Ann Surg 2000; 232: 733–742PubMedCrossRef

13.

Liu L, Hofstetter WL, Rashid A, Swisher SG, Correa AM, Ajani JA, Hamilton SR, Wu TT. Significance of the depth of tumor invasion and lymph node metastasis in superficially invasive (T1) esophageal adenocarcinoma. Am J Surg Pathol 2005; 29: 1079–1085PubMed

14.

Oh DS, Hagen JA, Chandrasoma PT, Dunst CM, Demeester SR, Alavi M, Bremner CG, Lipham J, Rizzetto C, Cote R, Demeester TR. Clinical biology and surgical therapy of intramucosal adenocarcinoma of the esophagus. J Am Coll Surg 2006; 203: 152–161PubMedCrossRef

15.

Altorki NK, Lee PC, Liss Y, Meherally D, Korst RJ, Christos P, Mazumdar M, Port JL. Multifocal neoplasia and nodal metastases in T1 esophageal carcinoma: implications for endoscopic treatment. Ann Surg 2008; 247: 434–439PubMedCrossRef

16.

Pennathur A, Farkas A, Krasinskas AM, Ferson PF, Gooding WE, Gibson MK, Schuchert MJ, Landreneau RJ, Luketich JD. Esophagectomy for T1 esophageal cancer: outcomes in 100 patients and implications for endoscopic therapy. Ann Thorac Surg 2009; 87: 1048–1054; discussion 1054–1045PubMedCentralPubMedCrossRef

17.

Sepesi B, Watson TJ, Zhou D, Polomsky M, Litle VR, Jones CE, Raymond DP, Hu R, Qiu X, Peters JH. Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens. J Am Coll Surg 2010; 210: 418–427PubMedCrossRef

18.

Griffin SM, Burt AD, Jennings NA. Lymph node metastasis in early esophageal adenocarcinoma. Ann Surg 2011; 254: 731–736; discussion 736–737PubMedCrossRef

19.

Dunbar KB, Spechler SJ. The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett's esophagus: a systematic review. Am J Gastroenterol 2012; 107: 850–862; quiz 863PubMedCentralPubMedCrossRef

20.

Ancona E, Rampado S, Cassaro M, Battaglia G, Ruol A, Castoro C, Portale G, Cavallin F, Rugge M. Prediction of lymph node status in superficial esophageal carcinoma. Ann Surg Oncol 2008; 15: 3278–3288PubMedCrossRef

21.

Buskens CJ, Westerterp M, Lagarde SM, Bergman JJ, ten Kate FJ, van Lanschot JJ. Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features. Gastrointest Endosc 2004; 60: 703–710PubMedCrossRef

22.

Westerterp M, Koppert LB, Buskens CJ, Tilanus HW, ten Kate FJ, Bergman JJ, Siersema PD, van Dekken H, van Lanschot JJ. Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction. Virchows Arch 2005; 446: 497–504PubMedCrossRef

23.

Bollschweiler E, Baldus SE, Schroder W, Prenzel K, Gutschow C, Schneider PM, Holscher AH. High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy 2006; 38: 149–156PubMedCrossRef

24.

Bolton WD, Hofstetter WL, Francis AM, Correa AM, Ajani JA, Bhutani MS, Erasmus J, Komaki R, Maru DM, Mehran RJ, Rice DC, Roth JA, Vaporciyan AA, Walsh GL, Swisher SG. Impact of tumor length on long-term survival of pT1 esophageal adenocarcinoma. J Thorac Cardiovasc Surg 2009; 138: 831–836PubMedCrossRef

25.

Yendamuri S, Swisher SG, Correa AM, Hofstetter W, Ajani JA, Francis A, Maru D, Mehran RJ, Rice DC, Roth JA, Walsh GL, Vaporciyan AA. Esophageal tumor length is independently associated with long-term survival. Cancer 2009; 115: 508–516PubMedCrossRef

26.

Wang BY, Goan YG, Hsu PK, Hsu WH, Wu YC. Tumor length as a prognostic factor in esophageal squamous cell carcinoma. Ann Thorac Surg 2011; 91: 887–893PubMedCrossRef

27.

Gockel I, Domeyer M, Sgourakis GG, Schimanski CC, Moehler M, Kirkpatrick CJ, Lang H, Junginger T, Hansen T. Prediction model of lymph node metastasis in superficial esophageal adenocarcinoma and squamous cell cancer including D2-40 immunostaining. J Surg Oncol 2009; 100: 191–198PubMedCrossRef

28.

Dicken BJ, Graham K, Hamilton SM, Andrews S, Lai R, Listgarten J, Jhangri GS, Saunders LD, Damaraju S, Cass C. Lymphovascular invasion is associated with poor survival in gastric cancer: an application of gene-expression and tissue array techniques. Ann Surg 2006; 243: 64–73PubMedCrossRef

29.

Ishii M, Ota M, Saito S, Kinugasa Y, Akamoto S, Ito I. Lymphatic vessel invasion detected by monoclonal antibody D2-40 as a predictor of lymph node metastasis in T1 colorectal cancer. Int J Colorectal Dis 2009; 24: 1069–1074PubMedCrossRef

30.

Arnaout-Alkarain A, Kahn HJ, Narod SA, Sun PA, Marks AN. Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer. Mod Pathol 2007; 20: 183–191PubMedCrossRef

Title: Depth of Submucosal Tumor Infiltration and its Relevance in Lymphatic Metastasis Formation for T1b Squamous Cell and Adenocarcinomas of the Esophagus
Authors: Michael F. Nentwich
Katharina von Loga
Matthias Reeh
Faik G. Uzunoglu
Andreas Marx
Jakob R. Izbicki
Dean Bogoevski
Publication date: 01-02-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 2/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-013-2367-2

At a glance: The STEP trials

Springer Medicine

Depth of Submucosal Tumor Infiltration and its Relevance in Lymphatic Metastasis Formation for T1b Squamous Cell and Adenocarcinomas of the Esophagus

Abstract

Background

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

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