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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2008

01-11-2008 | Gastrointestinal Oncology

Prediction of Lymph Node Status in Superficial Esophageal Carcinoma

Authors: Ermanno Ancona, MD, FACS, Sabrina Rampado, MD, Mauro Cassaro, MD, Giorgio Battaglia, MD, Alberto Ruol, MD, FACS, Carlo Castoro, MD, Giuseppe Portale, MD, Francesco Cavallin, PhD, Massimo Rugge, MD, FACS

Published in: Annals of Surgical Oncology | Issue 11/2008

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Abstract

Background

Esophageal carcinoma is among the cancers with the worst prognosis. Real chances for cure depend on both early recognition and early treatment. The ability to predict lymph node involvement allows early curative treatment with less invasive approaches.

Aims

To determine clinicohistopathological criteria correlated with lymph node involvement in patients with early esophageal cancer (T1) and to identify the best candidate patients for local endoscopic or less invasive surgical treatments.

Methods

A total of 98 patients with pT1 esophageal cancer [67 with squamous cell carcinomas (SCC) and 31 with adenocarcinomas (ADK)] underwent Ivor–Lewis or McKeown esophagectomy in the period between 1980 and 2006 at our institution. Based on the depth of invasion, lesions were classified as m1, m2, or m3 if mucosal, and sm1, sm2, or sm3 if submucosal.

Results

The rates of lymph node metastasis were 0% for the 27 mucosal carcinomas (T1m) and 28% for the 71 submucosal (T1sm) carcinomas (P < 0.001). Sm1 carcinomas were associated with a lower rate of lymph-node metastasis (8.3% versus 49 % sm2/3, P  = 0.003). As for histotype, the rates of lymph node metastasis for sm1 were 0% for ADK and 12.5% for SCC; for sm2/3 there were no significant differences. On multivariate analysis, depth of infiltration, lymphocytic infiltrate, angiolymphatic and neural invasion were significantly associated with lymph node involvement. Neural invasion was the single parameter with the greatest accuracy (82%); depth of infiltration and angiolymphatic invasion had 75% accuracy. Altogether these three parameters had an accuracy of 97%. Five-year survival rate was 56.7% overall: 77.7% for T1m and 53.3% for T1sm (P  = 0.048).

Conclusions

The most important factors for predicting lymph node metastasis in early esophageal cancer are depth of tumor infiltration, angiolymphatic invasion, neural invasion and grade of lymphocytic infiltration. The best candidates for endoscopic therapy are tumors with high-grade lymphocytic infiltration, no angiolymphatic or neural invasion, mucosal infiltration or sm1 (only for ADK), and tumor <1 cm in size. For sm SCC and sm2/3 ADK the treatment of choice remains esophagectomy with standard lymphadenectomy.
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Metadata
Title
Prediction of Lymph Node Status in Superficial Esophageal Carcinoma
Authors
Ermanno Ancona, MD, FACS
Sabrina Rampado, MD
Mauro Cassaro, MD
Giorgio Battaglia, MD
Alberto Ruol, MD, FACS
Carlo Castoro, MD
Giuseppe Portale, MD
Francesco Cavallin, PhD
Massimo Rugge, MD, FACS
Publication date
01-11-2008
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 11/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-008-0065-1

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