title: Prediction of lymph node status in superficial esophageal carcinoma.
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.
  
  
  OBJECTIVE
  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.
authors: Istituto Oncologico Veneto (IOV-IRCCS) University of Padova School of Medicine, Padova, Italy. ermanno.ancona@unipd.it
authors: Ermanno
authors: E
authors: Ancona
authors: Sabrina
authors: S
authors: Rampado
authors: Mauro
authors: M
authors: Cassaro
authors: Giorgio
authors: G
authors: Battaglia
authors: Alberto
authors: A
authors: Ruol
authors: Carlo
authors: C
authors: Castoro
authors: Giuseppe
authors: G
authors: Portale
authors: Francesco
authors: F
authors: Cavallin
authors: Massimo
authors: M
authors: Rugge
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D016629:Esophagectomy; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome