Prognostic relevance of histomorphological parameters and DNA content and their therapeutic consequences in esophageal carcinoma: a multivariate approach.
OBJECTIVE
Despite recent advances in surgical and multidisciplinary treatment, the prognosis for patients with esophageal carcinoma remains poor. The low prognostic accuracy of even surgical pathological TNM staging suggests that additional parameters would be useful in determining the prognosis.


METHODS
We undertook a retrospective analysis of 115 patients who had undergone transhiatal and transthoracic esophageal resection due to squamous cell carcinoma of the esophagus. In addition to TNM classification and the usual morphological criteria, a quantitative DNS analysis using Image DNA cytometry was performed. At the time of DNA analysis, histomorphological parameters and survival time was not known.


RESULTS
The main prognostic parameter was the curativity (R classification) of the operation. Using only patients who had had R0 resection, a multivariate analysis was performed. Parameters included: patient age; preoperative ASA classification; tumor localization; pN category; number of intra-thoracal lymph nodes removed; pT category; pM category; grading; lymphangiosis; ploidy; operative procedure, and the development of postoperative complications identifying the ploidy, and the depth of tumor infiltration of prognostically independent factors.


CONCLUSIONS
In the case of a diploid or tetraploid DNA content, tumor resection is recommended even in the case of lymph node metastasis at the truncus coeliacus. Patients with a diploid or tetraploid tumor without distant metastasis and tumor stage pT1-pT3 may, after curative (RO) transthoracic resection with two-field lymph node dissection, have an advantage over patients having a transmediastinal procedure in terms of long-term follow up. In cases of aneuploid DNA content, tumor resection shows no advantage over palliative non-operative procedures. Preoperative radio- or chemotherapy may improve the prognosis of these patients.
Department of Surgery, Johannes Gutenberg University, Mainz, Germany.
T
T
Boettger
P
P
Dutkowski
C J
CJ
Kirkpatrick
J K
JK
Seifert
T
T
Junginger
D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000235:genetics* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004247:DNA / Q000032:analysis*; D004938:Esophageal Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011003:Ploidies; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
D004247:DNA