Caustic ingestion and oesophageal cancer: intra- and peri-tumoral fibrosis is associated with a better prognosis.
OBJECTIVE
Oesophageal carcinoma is a well-known late complication of caustic ingestion, occurring in up to 7% of cases. We report a large series of patients with oesophageal scar cancer (SC), investigating the association between fibrosis and survival.


METHODS
A total of 25 patients with a history of oesophageal SC (1979-2005) were retrospectively studied. The amount of intra- and peri-tumoral fibrotic tissue was measured with Azan-Mallory staining. A control group of patients with non-SC was used for comparison.


RESULTS
Twenty-five patients (16 males:9 females, median age 59 years), presented with SC. The histotype was squamous cell carcinoma (SCC) in 20 (80%) patients, adenocarcinoma (AC) in three (12%) and verrucous carcinoma in two (8%). Oesophageal resection was performed in 17 of 25 (68%) patients; in eight (32%), only a palliative treatment (endoscopic/surgical) was possible. Mortality and morbidity rates were 4% and 40%, respectively. One-, 3- and 5-year overall actuarial survival rates for SC patients were 72%, 56% and 52%, respectively. The amount of fibrotic tissue around/within the tumour was significantly higher in SC patients (34.5% vs 5.9% non-SC, p=0.01); these patients had also a higher prevalence of tumours limited to the muscular wall (pT1-T2) (76% vs 28% non-SC, p<0.0001) and less lymph node metastases in T1-T2 cases (8% vs 34% non-SC, p=0.07). The 5-year survival was significantly better in SC patients: 71% versus 24% for resected cancers (p<0.0001), and 52% versus 15% for all observed patients (p=0.0001).


CONCLUSIONS
The presence of fibrotic tissue around/within the tumour is associated with a better prognosis in SC. Fibrosis might offer a protection against both local spread and nodal dissemination.
Ruol
Alberto
A
Department of Gastroenterological and Surgical Sciences, Clinica Chirurgica III, University of Padova School of Medicine, Via Giustiniani 2, 35128 Padova, Italy. alberto.ruol@unipd.it
Rampado
Sabrina
S
Parenti
Anna
A
Portale
Giuseppe
G
Giacomelli
Luciano
L
Battaglia
Giorgio
G
Cagol
Matteo
M
Ancona
Ermanno
E
D000230:Adenocarcinoma / Q000139:chemically induced / Q000150:complications / Q000601:surgery; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced / Q000150:complications / Q000601:surgery; D018289:Carcinoma, Verrucous / Q000139:chemically induced / Q000150:complications / Q000601:surgery; D002424:Caustics / Q000633:toxicity*; D002921:Cicatrix / Q000139:chemically induced / Q000150:complications; D004812:Epidemiologic Methods; D004938:Esophageal Neoplasms / Q000139:chemically induced* / Q000150:complications / Q000601:surgery; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000150:complications; D016629:Esophagectomy / Q000379:methods; D004947:Esophagus / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis
D002424:Caustics