Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus

Abstract

We examined lymph node metastasis clinicopathologically in 236 cases of superficial cancer (T1, Tis) of the thoracic esophagus surgically resected at our department without adjuvant treatment. Mucosal cancer was observed in 112 cases (47%) and submucosal cancer in 124 cases (53%). Lymph node metastasis was present in 3% of mucosal cancer cases and 41% of submucosal cancer cases. By the recent pathologic subclassification of the extent of the cancerous invasion in superficial esophageal cancer, mucosal cancer and submucosal cancer were each divided into three subtypes according to the extent of invasion, i.e. m1, m2, m3, sm1, sm2 and sm3 cancers. There was no case of lymph node metastasis in m1 and m2 cases, but it was observed in 8% of m3 cases, in 11% of sm1 cases, in 30% of sm2 cases and in 61% of sm3 cases. The number of involved nodes was three or less in m3 and sm1 cases, however four or more involved nodes were observed in 14% of sm2 cases and in 24% of sm3 cases. Positive lymph nodes were found only in the mediastinum in m3 and sm1 cases. On the contrary, they were found extensively in the mediastinum, the abdomen and the neck and in two or more regions in 27% of sm2 cases and in 38% of sm3 cases. Considering the location of positive nodes, the recurrent nerve lymph nodes were most frequently involved, followed by the cardiac lymph nodes. A similar tendency was observed in cases with single node metastasis. The 5-year survival rate of cases from m1 to sm1 was similar. That of sm3 cases was significantly worse than that of other groups. Based on the clinical results, the therapeutic guidelines for superficial cancer of the thoracic esophagus are considered to be as follows: (i) in m1 and m2 cancer, endoscopic mucosal resection is generally indicated in principle, although transhiatal esophagectomy may be indicated in some cases; (ii) in m3 and sm1 cancer, endoscopic mucosal resection is performed initially, then subsequent treatment is selected if necessary; (iii) in sm2 and sm3 cancer, conventional transthoracic esophagectomy with systematic lymph node dissection is indicated.

p12CDK2-AP1 is associated with tumor progression and a poor prognosis in esophageal squamous cell carcinoma

“…the muscularis mucosa; sm1, tumors invading the most superficial 1/3 of the submucosa; sm2/3, tumors invading deeper than sm1 level) (16,(18)(19)(20)(21)(22). Eguchi et al (21) demonstrated that lymph node metastasis was found in 0, 6, 18, 53 and 54% of m1, m2, m3, sm1 and sm2/3 lesions, respectively.…”

EUS Staging of Luminal Cancers in the Upper GI Tract

“…This stage is further sub-divided to T1a (also known as T1m and further subdivided to m1: limited to the epithelial layer, m2: invading lamina propria and m3: invading into but not through muscularis mucosa) for tumors that invade the lamina propria or muscularis mucosa; and T1b (also known as T1sm and further subdivided into thirds to sm1, sm2 and sm3: deepest one third of the submucosa) for tumors that invade the submucosa [1,13,18]. The depth of invasion predicts the probability of lymph node metastasis, vascular invasion and long-term survival [19]. There has been much debate and controversy regarding the staging modality for early esophageal cancers.…”

The New Era of Staging as a Key for an Appropriate Treatment for Esophageal Cancer

“…The lymphatic network is developed and widely spread, lymph node (LN) metastases are very common even in the case of superficial cancer not only in the mediastinum but also in the neck and the abdomen. [1][2][3][4][5] Therefore, the prognosis of thoracic esophageal cancer has been improved since the prevalence of the three-field LN dissection. 6,7) The plenty number of stocked data from the patients have proved the accurate percentage of LN metastases and prognosis after surgery, according to the tumor extent.…”

“…6,7) The plenty number of stocked data from the patients have proved the accurate percentage of LN metastases and prognosis after surgery, according to the tumor extent. [2][3][4][5]8) Esophageal squamous cell carcinoma (ESSC) is known to be sensitive to chemo-radiotherapy (CRT). Recent improvements of clinical results in CRT also added the choice for treatment.…”