Can clinical and endoscopic findings accurately predict early-stage adenocarcinoma?
BACKGROUND
The presentation and management of esophageal cancer are changing, as more patients are diagnosed at an earlier stage of the disease in which endoscopic treatment methods may be contemplated. Therefore, we conducted a study to determine whether symptomatic and endoscopic findings can accurately identify node-negative early-stage adenocarcinoma.


METHODS
A total of 213 consecutive patients (171 men and 42 women) with resectable esophageal adenocarcinoma seen from 1992 to 2002 were evaluated. None of these patients received neoadjuvant chemotherapy or radiation therapy. Using a multivariable model, model-based probabilities of early-stage disease (T1 im/sm N0) were calculated for each combination of the following three features: no dysphagia as main symptom at presentation, tumor length <or=2 cm, and noncircumferential lesion.


RESULTS
Eighty-two percent of the patients with all three characteristics presented with early-stage disease. Even in the setting of small, visible, noncircumferential tumors/nodules in patients without dysphagia, 14% of the patients harbored node metastasis.


CONCLUSIONS
Simple clinical and endoscopic findings predicted early-stage disease in 82% of cases, whereas a small but significant percentage had node metastasis. Because node metastasis predisposes to local failure in nonresectional treatment options such as endoscopic mucosal resection and photodynamic therapy, such findings should have a significant bearing on treatment decisions.
Portale
G
G
Division of Thoracic and Foregut Surgery, University of Southern California, 1510 San Pablo Street, Los Angeles, CA 90033, USA.
Peters
J H
JH
Hsieh
C-C
CC
Hagen
J A
JA
DeMeester
S R
SR
DeMeester
T R
TR
D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D000740:Anemia / Q000209:etiology; D001471:Barrett Esophagus / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D004938:Esophageal Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology