Evaluation of Lymphatic Spread, Visceral Metastasis and Tumoral Local Invasion in Esophageal Carcinomas

Abstract

Background: Knowing esophageal tumors behavior in relationship to lymph node involvement, distant metastases and local tumor invasion is of paramount importance for the best esophageal tumors management. Aim: To describe lymph node involvement, distant metastases, and local tumor invasion in esophageal carcinoma, according to tumor topography and histology. Methods: A total of 444 patients with esophageal squamous cell carcinoma and 105 adenocarcinoma were retrospectively analyzed. They were divided into four groups: adenocarcinoma and squamous cell carcinoma in the three esophageal segments: cervical, middle, and distal. They were compared based on their CT scans at the time of the diagnosis. Results: Nodal metastasis showed great relationship with of primary tumor site. Lymph nodes of hepatogastric, perigastric and peripancreatic ligaments were mainly affected in distal tumors. Periaortic, interaortocaval and portocaval nodes were more commonly found in distal squamous carcinoma; subcarinal, paratracheal and subaortic nodes in middle; neck chains were more affected in cervical squamous carcinoma. Adenocarcinoma had a higher frequency of peritoneal involvement (11.8%) and liver (24.5%) than squamous cell carcinoma. Considering the local tumor invasion, the more cranial neoplasia, more common squamous invasion of airways, reaching 64.7% in the incidence of cervical tumors. Middle esophageal tumors invade more often aorta (27.6%) and distal esophageal tumors, the pericardium and the right atrium (10.4%). Conclusion: Esophageal adenocarcinoma and squamous cell carcinoma in different topographies present peculiarities in lymph node involvement, distant metastasis and local tumor invasion. These differences must be taken into account in esophageal cancer patients' care.

Patterns of Distant Metastasis Between Histological Types in Esophageal Cancer

“…Similarly to previous studies that included patients with distant disease at initial diagnosis or who developed distant metastasis during follow-up ( 8 , 9 ), we found the liver was the most common site of distant metastasis in esophageal cancer overall, followed by the lymph nodes, lung, bone and brain. Up to now, the patterns of distant metastasis in SCC and AC have been poorly defined.…”

“…We also observed SCC had a significantly higher risk of lung metastasis. Previous studies reported the frequency of lung metastasis was not significantly different between SCC and AC ( 9 , 10 ). In a study of 35 Chinese patients with SCC and distant metastasis, 22 (62.9%) had lung metastasis and two (5.8%) had liver metastasis ( 12 ).…”

“…Tustumi et al . found patients with AC were more likely to have liver metastasis than patients with SCC (13.7% vs. 24.5%, p = 0.002), with no significant difference in metastasis to lung (9.8% vs. 14.8%, p = 0.254), bone (11.8% vs. 8.4%, p = 0.416) or brain (4.9% vs. 2.5%, p = 0.524) ( 9 ). Quint et al also reported AC had a higher incidence of liver metastasis than SCC (37.9% vs. 9%, p < 0.001), with no significant differences in lung, bone, and brain metastasis ( 10 ).…”

Pathologic Complete Response (Ypt0 Ypn0) After Chemotherapy and Radiotherapy Neoadjuvant Followed by Esophagectomy in the Squamous Cell Carcinoma of the Esophagus

“…The chemotherapeutic agents were cisplatin and 5FU (scheme Al Sarraf - for 21 patients) and carbotaxol and cisplatin (n=13); this treatment was combined with radiotherapy 1 , 11 , 12 , 15 , 23 , 43 .…”

“…The neoadjuvant therapy as a therapeutic strategy in esophageal squamous cell carcinoma has been used for many years 19 , 20 . This neoadjuvance may be only preoperative radiotherapy in the tumor area or, more recently, the use of associated radiotherapy and chemotherapy, thus affecting the tumor area and possible metastases 15 , 43 .…”