Top

World Journal of Surgery

Published in:

01-08-2019 | Metastasis | Original Scientific Report

Significance of Intramural Metastasis in Patients with Esophageal Squamous Cell Carcinoma: An Indicator of Aggressive Cancer Behavior

Authors: Akihiko Okamura, Masayuki Watanabe, Ryotaro Kozuki, Tasuku Toihata, Keita Takahashi, Yu Imamura, Shinji Mine

Published in: World Journal of Surgery | Issue 8/2019

Abstract

Background

Intramural metastasis (IM) is occasionally noted in patients with esophageal squamous cell carcinoma (ESCC). However, few recent studies have investigated the clinicopathological characteristics of IM and its survival impact. The present study aimed to clarify the clinicopathological and prognostic significance of IM in patients with ESCC.

Methods

We retrospectively examined 918 consecutive patients who underwent curative intent esophagectomy for ESCC. IM was defined as a pathologically confirmed metastatic lesion, which was clearly separate from the primary tumor and located within the esophageal or gastric wall. The clinicopathological characteristics and survival impact of IM were evaluated. A propensity score-matched analysis was performed to further elucidate the prognostic impact of IM.

Results

Among 918 patients, 46 (5.0%) had IM. Advanced tumors were significantly more frequent in patients with IM than in those without IM. The curative resection rate was lower in patients with IM (P = 0.001). Overall survival (OS) and disease-specific survival (DSS) were worse in patients with IM (both P < 0.001). In multivariate Cox proportional hazard analysis, IM presence was an independent poor prognostic indicator for OS and DSS (both P < 0.001). After propensity score matching, advanced tumors according to pathological N stage and lymphatic invasion were more frequent in patients with IM (P = 0.015 and 0.004, respectively). Additionally, OS and DSS were different between patients with and those without IM (both P = 0.002).

Conclusions

IM from ESCC is a local indicator of lymphatic invasion and advanced cancer, as well as an independent factor for poor prognosis.

Available only for authorised users

Takubo K, Sasajima K, Yamashita K et al (1990) Prognostic significance of intramural metastasis in patients with esophageal carcinoma. Cancer 65:1816–1819CrossRefPubMed

Kato H, Tachimori Y, Watanabe H et al (1992) Intramural metastasis of thoracic esophageal carcinoma. Int J Cancer 50:49–52CrossRefPubMed

Kuwano H, Watanabe M, Sadanaga N et al (1994) Univariate and multivariate analyses of the prognostic significance of discontinuous intramural metastasis in patients with esophageal cancer. J Surg Oncol 57:17–21CrossRefPubMed

Nishimaki T, Suzuki T, Tanaka Y et al (1996) Intramural metastases from thoracic esophageal cancer: local indicators of advanced disease. World J Surg 20:32–37. https://doi.org/10.1007/s002689900006 CrossRefPubMed

Hokamura N, Kato H, Tachimori Y et al (2000) Preoperative chemotherapy for esophageal carcinoma with intramural metastasis. J Surg Oncol 75:117–121CrossRefPubMed

Yuasa N, Miyake H, Yamada T et al (2004) Prognostic significance of the location of intramural metastasis in patients with esophageal squamous cell carcinoma. Langenbecks Arch Surg 389:122–127CrossRefPubMed

Hashimoto T, Arai K, Yamashita Y et al (2013) Characteristics of intramural metastasis in gastric cancer. Gastric Cancer 16:537–542CrossRefPubMed

Moon DH, Jeon JH, Yang HC et al (2018) Intramural metastasis as a risk factor for recurrence in esophageal squamous cell carcinoma. Ann Thorac Surg 106:249–256CrossRefPubMed

Kuwano H, Nishimura Y, Oyama T et al (2015) Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus 12:1–30CrossRefPubMed

10.

Ando N, Kato H, Igaki H et al (2012) A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol 19:68–74CrossRefPubMed

11.

Kuwano H, Nishimura Y, Ohtsu A et al (2008) Guidelines for diagnosis and treatment of carcinoma of the esophagus: April 2007 edition: part I edited by the Japan Esoplageal Society. Esophagus 5:61–73CrossRef

12.

Kuwano H, Nishimura Y, Ohtsu A et al (2008) Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2007 edition: part II edited by the Japan Esophageai Society. Esophagus 5:117–132CrossRef

13.

International Union Against Cancer (2017) In: Brierley JDGM, Wittekind C (eds) TNM classification of malignant tumors, 8th edn. Wiley, Oxford

14.

Watson W (1933) Carcinoma of the esophagus. Surg Gynecol Obstet 56:884–897

15.

Okamura A, Watanabe M, Mine S et al (2017) Failure of neoadjuvant chemotherapy for resectable esophageal squamous cell carcinoma. Dis Esophagus 30:1–8CrossRefPubMed

16.

Hara H, Tahara M, Daiko H et al (2013) Phase II feasibility study of preoperative chemotherapy with docetaxel, cisplatin, and fluorouracil for esophageal squamous cell carcinoma. Cancer Sci 104:1455–1460CrossRefPubMed

17.

Watanabe M, Baba Y, Yoshida N et al (2014) Outcomes of preoperative chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by esophagectomy in patients with resectable node-positive esophageal cancer. Ann Surg Oncol 21:2838–2844CrossRefPubMed

18.

Shiraishi O, Yamasaki M, Makino T et al (2017) Feasibility of preoperative chemotherapy with docetaxel, cisplatin, and 5-fluorouracil versus adriamycin, cisplatin, and 5-fluorouracil for resectable advanced esophageal cancer. Oncology 92:101–108CrossRefPubMed

19.

Yang H, Liu H, Chen Y et al (2018) Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): a phase III multicenter, randomized, open-label clinical trial. J Clin Oncol 36:2796–2803CrossRefPubMedPubMedCentral

Title: Significance of Intramural Metastasis in Patients with Esophageal Squamous Cell Carcinoma: An Indicator of Aggressive Cancer Behavior
Authors: Akihiko Okamura
Masayuki Watanabe
Ryotaro Kozuki
Tasuku Toihata
Keita Takahashi
Yu Imamura
Shinji Mine
Publication date: 01-08-2019
Publisher: Springer International Publishing
Keywords: Metastasis
Esophagus Resection
Esophagus Resection
Published in: World Journal of Surgery / Issue 8/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-05004-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Significance of Intramural Metastasis in Patients with Esophageal Squamous Cell Carcinoma: An Indicator of Aggressive Cancer Behavior

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2019

Timing of Parathyroidectomy Does Not Influence Renal Function After Kidney Transplantation

Perioperative Mortality Rates as a Health Metric for Acute Abdominal Surgery in Low- and Middle-Income Countries: A Systematic Review and Future Recommendations

Small and Laterally Placed Incisional Hernias Can be Safely Managed with an Onlay Repair

Infrahepatic Inferior Vena Cava Semi-Clamping can Reduce Blood Loss During Hepatic Resection but Still Requires Monitoring to Avoid Acute Kidney Injury

Sentinel Lymph Node Biopsy in Early Breast Cancer: Magnetic Tracer as the Only Localizing Agent

Years of Life Lost for Older Patients After Colorectal Cancer Diagnosis