title: Lymphovascular invasion as a tool to further subclassify T1b esophageal adenocarcinoma.
abstract: BACKGROUND
  Lymphovascular invasion (LVI) and/or lymph node metastases (LNM) adversely influence the overall survival (OS) of patients with T1 esophageal adenocarcinoma. Although endoscopic therapy may be adequate for patients with T1a cancer, patients with T1b cancer require esophagectomy/lymphadenectomy. The authors hypothesized that LVI status would subclassify T1b cancers and facilitate new therapeutic strategies.
  
  
  METHODS
  Ninety-nine consecutive patients with T1 adenocarcinoma were analyzed after they underwent esophagectomy/lymphadenectomy. LNM was assessed in all patients, and LVI was assessed in 89 patients. OS was correlated with pathologic cancer stage in association with LVI and LNM.
  
  
  RESULTS
  The 5-year OS rate for patients with T1a tumors (88%) was superior to that for patients with T1b tumors (62%; P = .001). The 5-year OS rate for patients who had cancers without LVI (85%) was superior to the rate for patients who had cancers with LVI (36%; P = .0001). It is noteworthy that, for cancers without LVI, the 5-year OS rate for patients with T1b tumors (77%) was similar to the rate for patients with T1a tumors (90%; P = .08), but it was superior to the rate for patients with T1b tumors that had LVI (27%; P = .006). The presence of LVI and/or LNM resulted in worse 5-year OS (< or =37%) compared with the lack of LVI and/or LNM (88%; P < .001). The rate of LNM for patients who had T1b tumors without LVI still was 19%, and the relapse rate was 16%.
  
  
  CONCLUSIONS
  The current results demonstrated that LVI distinguishes the biologic behavior of early esophageal cancer, and patients who have T1b cancer without LVI have a clinical biology similar to that of patients with T1a cancer. If LNM before surgery can be diagnosed with high sensitivity by better endoscopic techniques and/or molecular biomarkers, then a new therapeutic paradigm for T1b cancers could emerge. Further research is needed on patients with T1b esophageal adenocarcinoma.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Putao
authors.initials: P
authors.lastname: Cen
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Tsung-Teh
authors.initials: TT
authors.lastname: Wu
authors.forename: Jeffery H
authors.initials: JH
authors.lastname: Lee
authors.forename: William A
authors.initials: WA
authors.lastname: Ross
authors.forename: Marta
authors.initials: M
authors.lastname: Davilla
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Norio
authors.initials: N
authors.lastname: Fukami
authors.forename: Asif
authors.initials: A
authors.lastname: Rashid
authors.forename: Dipen
authors.initials: D
authors.lastname: Maru
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000098:blood supply* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D016019:Survival Analysis