Impact of tumor length on long-term survival of pT1 esophageal adenocarcinoma.
BACKGROUND
The impact of esophageal tumor length on pT1 esophageal adenocarcinoma has not been well evaluated.


METHODS
Case histories of all patients (n = 133) undergoing esophageal resection from 1979 to 2007 with pT1 adenocarcinoma of the esophagus were reviewed. Univariate and multivariate analyses of esophageal tumor length and other standard prognostic factors were performed.


RESULTS
Patients with early-stage pT1 esophageal adenocarcinoma with tumors less than 3 cm demonstrate decreased long-term survival (3 years: >3 cm = 46% vs 93%; P < .001) and higher risk of lymph node involvement (lymph node positive: >3 cm = 47% vs 10%; P < .001). Multivariable analysis shows that esophageal tumor length (>3 cm) is an independent risk factor for survival in patients with pT1 early-stage esophageal cancer (hazard ratio: 4.8, 95% confidence intervals: 1.4-16.5; P < .001) even when controlled for submucosal involvement, lymph node involvement, and lymphatic/vascular invasion status. In combination with submucosal involvement, esophageal tumor length (>3 cm) identifies a high-risk population of pT1 esophageal adenocarcinoma (3 years: group 1 [0 risk factors] = 100%, group 2 [1 risk factor] = 87%, and group 3 [2 risk factors] = 33%; P < .001).


CONCLUSIONS
This study demonstrates that esophageal tumor length (>3 cm) is a risk factor for long-term survival and lymph node involvement in early-stage pT1 esophageal adenocarcinoma. Esophageal tumor length (>3 cm) in combination with submucosal involvement may help to identify a high-risk group of patients with pT1 esophageal adenocarcinoma.
Bolton
William D
WD
Department of Thoracic and Cardiovascular Surgery, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.
Hofstetter
Wayne L
WL
Francis
Ashleigh M
AM
Correa
Arlene M
AM
Ajani
Jaffer A
JA
Bhutani
Manoop S
MS
Erasmus
Jeremy
J
Komaki
Ritsuko
R
Maru
Dipen M
DM
Mehran
Reza J
RJ
Rice
David C
DC
Roth
Jack A
JA
Vaporciyan
Ara A
AA
Walsh
Garrett L
GL
Swisher
Stephen G
SG
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis