Evaluation of an Indicator for Lymph Node Metastasis of Esophageal Squamous Cell Carcinoma Invading the Submucosal Layer

Abstract

Lymph node metastasis is a major prognostic factor for esophageal squamous cell carcinoma (ESCC). In recent years, endoscopic mucosal resection (EMR) has been developed with excellent results for the treatment of the superficial ESCC. To make the EMR treatment successful, it is important to establish a good indicator to identify ESCC patients at a high risk of lymph node metastasis. In this study, we examined clinicopathological and immunohistochemical factors to investigate the factors involved in lymph node metastasis of ESCC invading to the submucosal layer (sm‐ESCC). Surgical specimens from 84 sm‐ESCC patients were examined. Among 84 sm‐ESCC patients, 33 (39.3%) had lymph node metastases. Clinicopathologically, tumor depth, lymphatic invasion and blood vessel invasion showed significant correlations with lymph node metastasis by univariate analysis. Tumor depth and lymphatic invasion showed significant correlations by multivariate analysis of these factors. Immunohistochemically, P53 accumulation was observed in 45 cases (53.6%), cyclin D1 overexpression in 25 (29.8%), and pRB in 65 (77.4%). P53 accumulation, cyclin D1 overexpression and MIB‐1 Labeling Index were significantly associated with lymph node metastasis by univariate analysis, and P53 accumulation showed a significant correlation with lymph node metastasis by multivariate analysis. Among tumor depth, lymphatic invasion and P53 accumulation, tumor depth and lymphatic invasion were significantly correlated with lymph node metastasis (P=0.0023 and P=0.0092, respectively) by multivariate analysis. These data suggest that tumor depth and lymphatic invasion can be considered as good indicators for lymph node metastasis among patients with sm‐ESCC. In addition, P53 accumulation could be helpful to identify the patients who need additional treatment after EMR.

Parameters predicting lymph node metastasis in patients with superficial esophageal squamous cell carcinoma

“…Angiolymphatic invasion was also related to lymph node metastasis in the total 271 patients, consistent with previous studies 6, 7, 10, 11 . But it was only borderline significantly related with lymph node metastasis ( P =0.067) in the 170 tissue microarray cases with submucosal invasion thickness ≥250µm.…”

Predictive factors for lymph node metastasis in esophageal squamous cell carcinomas contacting or penetrating the muscularis mucosae: the utility of droplet infiltration

“…The reason we assumed all free cancer cell nests to be DI and examined their longitudinal diameter, number of the constituent cells, and distance from the primary focus was because this was a practical approach. Vessel permeation is a relatively objective factor that has been reported most frequently as a predictive factor for lymph node metastasis [5,13,23]. However, its low sensitivity is a problem, with many lymph node metastasis-positive cases in the vessel permeation-negative group [24].…”

Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video)

“…Because patients with negligible risks of nodal involvement can be clearly identified histologically, [8][9][10][11][12] ER is also accepted as potentially curative in these patients. Consequently, conventional ER, especially EMR, is well-established for patients with mucosal SCCE and is reported to give disease-specific 5-year survival rates exceeding 90%, and serious complications seldom occur.…”