title: Treatment allocation in patients with early-stage esophageal adenocarcinoma: Prevalence and predictors of lymph node involvement.
abstract: In considering treatment allocation for patients with early esophageal adenocarcinoma, the incidence of lymph node metastasis is a critical determinant; however, this has not been well defined or stratified by the relevant clinical predictors of lymph node spread.
  
  
  
  Data from the Surveillance, Epidemiology, and End Results database of the National Cancer Institute were abstracted from 2004 to 2010 for patients with early-stage esophageal adenocarcinoma. The incidence of lymph node involvement for patients with Tis, T1a, and T1b tumors was examined and was stratified by predictors of spread.
  
  
  
  A total of 13,996 patients with esophageal adenocarcinoma were evaluated. Excluding those with advanced, metastatic, and/or invasive (T2-T4) disease, 715 patients with Tis, T1a, and T1b tumors were included. On multivariate analysis, tumor grade (odds ratio [OR], 2.76; 95% confidence interval [95% CI], 1.58-4.82 [P<.001]), T classification (OR, 0.47; 95% CI, 0.24-0.91 [P =.025]), and tumor size (OR, 2.68; 95% CI, 1.48-4.85 [P = .001]) were found to be independently associated with lymph node metastases. There was no lymph node spread noted with Tis tumors. For patients with low-grade (well or moderately differentiated) tumors measuring <2 cm in size, the risk of lymph node metastasis was 1.7% for T1a (P<.001) and 8.6% for T1b (P = .001) tumors.
  
  
  
  For patients with low-grade Tis or T1 tumors measuring ≤2 cm in size, the incidence of lymph node metastasis appears to be comparable to the mortality rate associated with esophagectomy. For highly selected patients with early esophageal adenocarcinomas, the results of the current study support the recommendation that local endoscopic resection can be considered as an alternative to surgical management when followed by rigorous endoscopic and radiographic surveillance. Cancer 2016;122:2150-7. © 2016 American Cancer Society.
authors.affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Gamboa
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Sungjin
authors.initials: S
authors.lastname: Kim
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Force
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.affiliation: Interventional Endoscopy, Gastroenterology and Nutrition, Cancer Treatment Centers of America, Newnan, Georgia.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Woods
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Luke
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Shaffer
authors.affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Sunil
authors.initials: S
authors.lastname: Dacha
authors.affiliation: Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Nabil F
authors.initials: NF
authors.lastname: Saba
authors.affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Keilin
authors.affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Cai
authors.affiliation: Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Bassel F
authors.initials: BF
authors.lastname: El-Rayes
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.|Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Field F
authors.initials: FF
authors.lastname: Willingham
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000066491:Clinical Decision-Making; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D011159:Population Surveillance; D015995:Prevalence; D011379:Prognosis
keywords: Barrett esophagus; early esophageal cancer; endoscopic mucosal surgical resection; esophageal adenocarcinoma; esophageal cancer