Risk Stratification for Early Esophageal Adenocarcinoma: Analysis of Lymphatic Spread and Prognostic Factors

Barbour, Andrew P.; Jones, Mark; Brown, Ian; Gotley, D. C.; Martin, Ian; Thomas, Janine; Clouston, Andrew D.; Smithers, B. Mark

doi:10.1245/s10434-010-1025-0

Cited by 90 publications

(100 citation statements)

References 60 publications

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“…It is hard to identify patients with high risk of lymph node metastases in mucosal tumor in our study as only one of the 62 patients with mucosal tumor had lymph node metastases (1.6%). According to the previous reports (Ancona et al, 2008;Barbour et al, 2010) and our finding, histologic grade was another factor associated with lymph node metastases in EEC. We think that for patients with poor differentiated mucosal tumors, careful selection should be made for patients to receive endoscopic treatment.…”

Section: Discussionsupporting

confidence: 75%

“…The number of metastatic lymph nodes has also been shown to be one of the most important independent prognostic factors for patients with esophageal cancer after curative resection (Rice et al, 2009;Rice et al, 2010). Previous studies with EEC also showed that lymph node metastasis was a significant predictor for survival (Westerterp et al, 2005;Barbour et al, 2010); Natsugoe et al, 2004;Tajima et al, 2000;Grotenhuis et al, 2010). In our study, although the 5-and 10-year overall survival rates of 83.0% and 71.8% for pN0 category patients were higher than those of 67.2% and 56.0% for pN+ category patients, the difference was not statistically significant (P=0.104).…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of patients with EEC has been increasing because of recent advances in endoscopic examinations and awareness of the clinical importance of Barrett's esophagus (Ishikawa et al, 2005;Stein et al, 2005;Westerterp et al, 2005;Tachibana et al, 2006;Saha et al, 2009;Barbour et al, 2010;DeMeester, 2010). Chaoshan area in Guangdong province, located at the southeast of China, is the only coastal region with a high incidence of esophageal cancer in China.…”

Section: Discussionmentioning

confidence: 99%

“…This definition also included patients who had resection for high-grade dysplasia (HGD), now termed intraepithelial neoplasia (HGIEN) (Schlemper et al, 2000). The incidence of patients with EEC has been increasing because of recent advances in endoscopic examinations and awareness of the clinical importance of Barrett's esophagus (Ishikawa et al, 2005;Stein et al, 2005;Westerterp et al, 2005;Tachibana et al, 2006;Saha et al, 2009;Barbour et al, 2010;DeMeester, 2010). Radical esophagectomy with lymphadenectomy are still the mainstay of curative treatment for patients with EEC at many centers, especially for patients with submucosal diseases (Stein et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…However, surgery has been challenged due to high morbidity and mortality rates related to the procedure and the low rate of lymph node metastases in EEC. Less invasive approach such as limited surgical resection, organ-preserving treatment and endoscopic therapy have been developed and applied in clinic (Stein et al, 2005;Westerterp et al, 2005;Tachibana et al, 2006;Saha et al, 2009;Barbour et al, 2010;Watanabe et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

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Surgical Treatment for Early Esophageal Squamous Cell Carcinoma

Chen

Weng²,

Wang³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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More studies are needed to clarify treatments and prognosis of early esophageal squamous cell carcinoma (ESCC). This retrospective study was designed to review the outcome of surgical treatment for early ESCC, evaluate the results of a left thoracotomy for selected patients with early ESCC, and identify factors affecting lymph node metastases and survival. The clinicopathological data of 228 patients with early ESCC who underwent transthoracic esophagectomy with lymphadenectomy without preoperative adjuvant treatment were reviewed. The χ 2 test or Fisher's exact test were used to detect factors related to lymph node metastasis. Univariate and multivariate analyses were performed to identify prognostic factors. There were 152 males and 76 females with a median age of 55 years. Two hundred and eight patients underwent a left thoracotomy, and the remaining 20 patients with lymph nodes in the upper mediastinum more than 5 mm in short-axis diameter by computed tomography scan underwent a right thoracotomy. No lymph node metastasis was found in the 18 patients with carcinoma in situ, while lymph node metastases were detected in 1.6% (1/62) of patients with mucosal tumours and 18.2% (27/148) of patients with submucosal tumours. Only 7 patients showed upper mediastinal lymph node metastases in the follow-up. The 5-and 10-year overall survival rates were 81.4% and 70.1%, respectively. Only histologic grade (P<0.001) and pT category (P=0.001) significantly correlated with the presence of lymph node metastases. In multivariate analysis, only histologic grade (P=0.026) and pT category (P=0.008) were independent prognostic factors. A left thoracotomy is acceptable for selected patients with early ESCC. Histologic grade and pT category affected the presence of lymph node metastases and were independent prognostic factors for early ESCC.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Surgical Treatment for Early Esophageal Squamous Cell Carcinoma

Chen

Weng²,

Wang³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Lymphovascular invasion quantification could improve risk prediction of lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma

et al. 2021

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Aim To quantify lymphovascular invasion (LVI) and to assess the prognostic value in patients with pT1b esophageal adenocarcinoma. Methods In this nationwide, retrospective cohort study, patients were included if they were treated with surgery or endoscopic resection for pT1b esophageal adenocarcinoma. Primary endpoint was the presence of metastases, lymph node metastases, or distant metastases, in surgical resection specimens or during follow‐up. A prediction model to identify risk factors for metastases was developed and internally validated. Results 248 patients were included. LVI was distributed as follows: no LVI (n = 196; 79.0%), 1 LVI focus (n = 16; 6.5%), 2–3 LVI foci (n = 21; 8.5%) and ≥4 LVI foci (n = 15; 6.0%). Seventy‐eight patients had metastases. The risk of metastases was increased for tumors with 2–3 LVI foci [subdistribution hazard ratio (SHR) 3.39, 95% confidence interval (CI) 2.10–5.47] and ≥4 LVI foci (SHR 3.81, 95% CI 2.37–6.10). The prediction model demonstrated a good discriminative ability (c‐statistic 0.81). Conclusion The risk of metastases is higher when more LVI foci are present. Quantification of LVI could be useful for a more precise risk estimation of metastases. This model needs to be externally validated before implementation into clinical practice.

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18. Endoscopic Ablative Therapy

Gilbert

Hunter

2012

The SAGES Manual

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Risk Stratification for Early Esophageal Adenocarcinoma: Analysis of Lymphatic Spread and Prognostic Factors

Cited by 90 publications

References 60 publications

Surgical Treatment for Early Esophageal Squamous Cell Carcinoma

Surgical Treatment for Early Esophageal Squamous Cell Carcinoma

Lymphovascular invasion quantification could improve risk prediction of lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma

18. Endoscopic Ablative Therapy

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