title: Can the Risk of Lymph Node Metastases Be Gauged in Endoscopically Resected Submucosal Esophageal Adenocarcinomas? A Multi-Center Study.
abstract: Endoscopic resection (ER) allows for local therapy of superficial esophageal cancers. Factors reported to be associated with an increased risk of lymph node metastases in patients with adenocarcinoma are poor differentiation, lymphovascular invasion (LVI), and submucosal invasion >500 μ. The aim of this study was to determine whether depth of invasion and tumor characteristics in an ER specimen can be used to gauge the risk of lymph node metastases in patients with superficial esophageal adenocarcinoma. Patients from seven US centers that had ER of an adenocarcinoma followed by an esophagectomy were identified. The ER pathology slides were rereviewed by three experienced GI pathologists for depth of invasion, presence of LVI, and tumor differentiation. The findings from the ER specimen were correlated with the presence and number of lymph node metastases in the final esophagectomy specimen. There were 19 T1a and 23 T1b tumors. A median of 24 nodes were resected per patient. None of the T1a tumors had involved lymph nodes despite the presence of LVI in 5% and poor differentiation in 21% of patients. In contrast, 26% of T1b tumors had involved nodes. None of the four patients with submucosal invasion ≤500 μ, no LVI, and no poor differentiation had involved nodes. However, with an increasing number of risk factors, the likelihood of involved lymph nodes increased, reaching 50% when all three factors were present. Endoscopic therapy appears appropriate for intramucosal tumors and may be an option for low-risk T1b tumors. Esophagectomy is preferred for patients with submucosal invasion and one or more risk factors.
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Boys
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Stephanie G
authors.initials: SG
authors.lastname: Worrell
authors.affiliation: Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Parakrama
authors.initials: P
authors.lastname: Chandrasoma
authors.affiliation: Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Vallone
authors.affiliation: Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Dipen M
authors.initials: DM
authors.lastname: Maru
authors.affiliation: Department of Pathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lizhi
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Shanda H
authors.initials: SH
authors.lastname: Blackmon
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Dickinson
authors.affiliation: Department of Surgery, Oregon Clinic, Portland, OR, USA.
authors.forename: Christy M
authors.initials: CM
authors.lastname: Dunst
authors.affiliation: Department of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.affiliation: Department of Surgery, University of Rochester, New York, NY, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lada
authors.affiliation: Department of Surgery, Swedish Cancer Institute, Seattle, WA, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Louie
authors.affiliation: Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Molena
authors.affiliation: Department of Surgery, University of Rochester, New York, NY, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Watson
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Suite 514, Los Angeles, CA, 90033, USA. steven.demeester@med.usc.edu.
authors.forename: Steven R
authors.initials: SR
authors.lastname: DeMeester
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Barrett’s esophagus; Endoscopic resection; Esophageal adenocarcinoma; Esophagectomy