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. 2010 Mar;8(3):248-53.
doi: 10.1016/j.cgh.2009.11.016. Epub 2009 Nov 27.

Depth of submucosal invasion does not predict lymph node metastasis and survival of patients with esophageal carcinoma

Rami J Badreddine  1 , Ganapathy A Prasad, Jason T Lewis, Lori S Lutzke, Lynn S Borkenhagen, Kelly T Dunagan, Kenneth K Wang
Affiliations

Depth of submucosal invasion does not predict lymph node metastasis and survival of patients with esophageal carcinoma

Rami J Badreddine et al. Clin Gastroenterol Hepatol. 2010 Mar.

Abstract

Background & aims: There is controversy over the outcomes of esophageal adenocarcinoma with superficial submucosal invasion. We evaluated the impact of depth of submucosal invasion on the presence of metastatic lymphadenopathy and survival in patients with esophageal adenocarcinoma.

Methods: Pathology reports of esophagectomy samples collected from 1997 to 2007 were reviewed. Specimens from patients with esophageal adenocarcinoma and submucosal invasion were reviewed and classified as superficial (upper 1 third, sm1) or deep (middle third, sm2 or deepest third, sm3) invasion. Outcomes studied were presence of metastatic lymphadenopathy and overall survival. Variables of interest were analyzed as factors that affect overall and cancer-free survival using Cox proportional hazards modeling. A multivariate model was constructed to establish independent associations with survival.

Results: The study included 80 patients; 31 (39%) had sm1 carcinoma, 23 (29%) had sm2 carcinoma, and 26 (33%) had sm3 carcinoma. Superficial and deep submucosal invasion were associated with substantial rates of metastatic lymphadenopathy (12.9% and 20.4%, respectively). The mean follow-up time was 40.5 +/- 4 months and the mean overall unadjusted survival time was 53.8 +/- 4.1 months. Factors significantly associated with reduced survival time included the presence of metastatic lymph nodes (hazard ratio [HR], 2.89; confidence interval [CI], 1.13-6.88) and esophageal cancer recurrence (HR 6.39, CI 2.40-16.14), but not depth of submucosal invasion.

Conclusions: Patients with sm1 esophageal carcinoma have substantial rates of metastatic lymphadenopathy. Endoscopic treatment of superficial submucosal adenocarcinoma is not advised for patients that are candidates for surgery.

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Figures

Figure 1
Figure 1
Fig 1a. SM1-High power view. Infiltrating malignant glands extend just through the muscularis mucosae into the loose connective tissue of the submucosa. Fig. 1b SM2-Low power view. Tumor extends into the middle third of the submucosa. The thick bundles of smooth muscle which compose the muscularis propria are seen at the bottom of the field. Fig. 1c SM3-Low power. Invasive adenocarcinoma abuts but does not invade the muscularis propria Fig. 1d Lymph node involved by metastatic adenocarcinoma from an SM3 case.
Figure 1
Figure 1
Fig 1a. SM1-High power view. Infiltrating malignant glands extend just through the muscularis mucosae into the loose connective tissue of the submucosa. Fig. 1b SM2-Low power view. Tumor extends into the middle third of the submucosa. The thick bundles of smooth muscle which compose the muscularis propria are seen at the bottom of the field. Fig. 1c SM3-Low power. Invasive adenocarcinoma abuts but does not invade the muscularis propria Fig. 1d Lymph node involved by metastatic adenocarcinoma from an SM3 case.
Figure 1
Figure 1
Fig 1a. SM1-High power view. Infiltrating malignant glands extend just through the muscularis mucosae into the loose connective tissue of the submucosa. Fig. 1b SM2-Low power view. Tumor extends into the middle third of the submucosa. The thick bundles of smooth muscle which compose the muscularis propria are seen at the bottom of the field. Fig. 1c SM3-Low power. Invasive adenocarcinoma abuts but does not invade the muscularis propria Fig. 1d Lymph node involved by metastatic adenocarcinoma from an SM3 case.
Figure 1
Figure 1
Fig 1a. SM1-High power view. Infiltrating malignant glands extend just through the muscularis mucosae into the loose connective tissue of the submucosa. Fig. 1b SM2-Low power view. Tumor extends into the middle third of the submucosa. The thick bundles of smooth muscle which compose the muscularis propria are seen at the bottom of the field. Fig. 1c SM3-Low power. Invasive adenocarcinoma abuts but does not invade the muscularis propria Fig. 1d Lymph node involved by metastatic adenocarcinoma from an SM3 case.
Fig. 2
Fig. 2
Overall unadjusted survival of patients with sm1 submucosal esophageal adenocarcinoma and sm2/sm3 submucosal esophageal adenocarcinoma (p=0.43-Red sm1, Blue sm2/3).
Fig. 3
Fig. 3
Cancer free survival of patients with sm1 submucosal esophageal adenocarcinoma and sm2/sm3 submucosal esophageal adenocarcinoma (p=0.48-Red sm1, Blue sm2/3).
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References

    1. Falk GW. Barrett’s esophagus. Gastroenterology. 2002;122:1569–91. - PubMed
    1. Devesa SS, Blot WJ, Fraumeni JF., Jr Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer. 1998;83:2049–53. - PubMed
    1. van Lanschot JJ, Hulscher JB, Buskens CJ, Tilanus HW, ten Kate FJ, Obertop H. Hospital volume and hospital mortality for esophagectomy. Cancer. 2001;91:1574–8. - PubMed
    1. Pacifico RJ, Wang KK, Wongkeesong LM, Buttar NS, Lutzke LS. Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett’s esophagus. Clin Gastroenterol Hepatol. 2003;1:252–7. - PubMed
    1. Buttar NS, Wang KK, Lutzke LS, Krishnadath KK, Anderson MA. Combined endoscopic mucosal resection and photodynamic therapy for esophageal neoplasia within Barrett’s esophagus. Gastrointest Endosc. 2001;54:682–8. - PubMed

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