title: Risk of metastasis in adenocarcinoma of the esophagus: a multicenter retrospective study in a Japanese population.
abstract: BACKGROUND
  Little is known about the specific risks of metastasis in esophageal adenocarcinoma in relation to invasion depth or other pathologic factors.
  
  
  METHODS
  We conducted a multicenter retrospective study in 13 high-volume centers in Japan from January 2000 to October 2014 to elucidate the risk of metastasis of esophageal adenocarcinoma. A total of 458 patients (217 surgically resected and 241 endoscopically resected) with esophageal adenocarcinoma or esophagogastric adenocarcinoma involving the esophagus were included. Metastasis was considered positive if there was histologically confirmed metastasis in the surgical specimen or clinically confirmed metastasis during follow-up. Metastasis was considered negative if no metastasis was identified in resected specimens and during follow-up in patients treated surgically or no metastasis during follow-up for >5 years in patients treated by endoscopic resection.
  
  
  RESULTS
  Metastasis was identified in 72 patients. Multivariate analysis confirmed lymphovascular involvement [odds ratio (OR) 6.20; 95 % confidence interval (CI) 3.12-12.32; p < 0.001], a poorly differentiated component (OR 3.69; 95 % CI 1.92-7.10; p < 0.001), and lesion size >30 mm (OR 3.12; 95 % CI 1.63-5.97; p = 0.001) as independent risk factors for metastasis. No metastasis was detected in patients with mucosal cancer without lymphovascular involvement and a poorly differentiated component (0/186 lesions) or in patients with cancer invading the submucosa (1-500 µm) without lymphovascular involvement, a poorly differentiated component, and ≤30 mm (0/32 lesions).
  
  
  CONCLUSIONS
  Mucosal and submucosal cancers (1-500 µm invasion) without risk factors have a low incidence of metastasis and may thus be good candidates for endoscopic resection.
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3 Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan. isihara-ry@mc.pref.osaka.jp.
authors.forename: Ryu
authors.initials: R
authors.lastname: Ishihara
authors.affiliation: Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan.
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Oyama
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Abe
authors.affiliation: Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
authors.affiliation: Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Fujisaki
authors.affiliation: Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Goda
authors.affiliation: Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenro
authors.initials: K
authors.lastname: Kawada
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Koike
authors.affiliation: Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Matsuda
authors.affiliation: Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Hirasawa
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Kodaira
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Omae
authors.affiliation: Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Matsui
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3 Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanesaka
authors.affiliation: Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hirooka
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Saito
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tsuji
authors.affiliation: Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Maeda
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Yamashita
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.affiliation: Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tomita
authors.affiliation: Department of Medical Informatics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsunaga
authors.affiliation: Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Terai
authors.affiliation: Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Soji
authors.initials: S
authors.lastname: Ozawa
authors.affiliation: Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Kawano
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Seto
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000473:pathology; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012307:Risk Factors; D047368:Tumor Burden
keywords: Barrett’s esophagus; Endoscopic resection; Esophageal cancer; Esophagogastric cancer; Metastasis