Significance of Intramural Metastasis in Patients with Esophageal Squamous Cell Carcinoma: An Indicator of Aggressive Cancer Behavior

Abstract

Background Intramural metastasis (IM) is occasionally noted in patients with esophageal squamous cell carcinoma (ESCC). However, few recent studies have investigated the clinicopathological characteristics of IM and its survival impact. The present study aimed to clarify the clinicopathological and prognostic significance of IM in patients with ESCC. Methods We retrospectively examined 918 consecutive patients who underwent curative intent esophagectomy for ESCC. IM was defined as a pathologically confirmed metastatic lesion, which was clearly separate from the primary tumor and located within the esophageal or gastric wall. The clinicopathological characteristics and survival impact of IM were evaluated. A propensity score-matched analysis was performed to further elucidate the prognostic impact of IM. Results Among 918 patients, 46 (5.0%) had IM. Advanced tumors were significantly more frequent in patients with IM than in those without IM. The curative resection rate was lower in patients with IM (P = 0.001). Overall survival (OS) and disease-specific survival (DSS) were worse in patients with IM (both P \ 0.001). In multivariate Cox proportional hazard analysis, IM presence was an independent poor prognostic indicator for OS and DSS (both P \ 0.001). After propensity score matching, advanced tumors according to pathological N stage and lymphatic invasion were more frequent in patients with IM (P = 0.015 and 0.004, respectively). Additionally, OS and DSS were different between patients with and those without IM (both P = 0.002). Conclusions IM from ESCC is a local indicator of lymphatic invasion and advanced cancer, as well as an independent factor for poor prognosis.

<p>MicroRNA-186-5p Inhibits Proliferation And Metastasis Of Esophageal Cancer By Mediating HOXA9</p>

“…In addition to their own unlimited proliferation, cancer cells will also be transferred to all parts of the body through the lymphatic system or circulatory system to grow and reproduce, resulting in cachexia and severe organ failure, etc., and eventually leading to the death of patients 6–8. Although great progress has been made in the diagnosis and treatment of ECa in the past decades, the prognosis of ECa, especially in patients with advanced and metastatic ECa, is still not satisfactory, and recurrence and metastasis are the main reasons for the failure of ECa treatment 8,9. Therefore, screening is an important method for early detection and early diagnosis of ECa, and improving the sensitivity and specificity of screening is the focus of current research 10–12…”

“…Because the early symptoms of ECa are not obvious and there is a lack of early diagnosis, most patients are in the advanced stage of disease at the time of the first diagnosis, and the 5-year survival rate of ECa after resection is 9.5–45% 8. Tumor invasion and metastasis are the main factors leading to the death of patients with ECa, which are mainly dependent on the activation of proto-oncogenes and the inactivation of tumor suppressor genes 9,10. If we can study the occurrence and development of ECa from the perspective of genetics and epigenetics, it will provide new targets and new strategies for the diagnosis and treatment of ECa 11,12…”

Intramural metastasis to the appendix from ascending colon cancer: a case report

“…However, there is a possibility of intramural metastasis from transverse colon cancer to the appendix; therefore, awareness of our rare case of intramural metastasis is important. Intramural metastasis is considered an important factor predicting poor prognosis in esophageal [3,8,9], gastric [2], and rectal [5] cancers. Although there is a lack of consensus regarding treatment strategies, intramural metastasis might also be a poor prognostic factor in metastasis from colon cancer to the appendix.…”

“…Intramural metastasis is rare in colorectal cancer, although this type of metastasis has been frequently reported in esophageal and gastric cancer [1,2]. The presence of intramural metastasis is an important poor prognostic indicator [3]. We report an extremely rare case of intramural metastasis from ascending colon cancer to the appendix.…”

Treatment Strategy for Esophageal Squamous Cell Carcinoma With Endoscopic Intramural Metastasis

“…Pathologically diagnosed intramural metastasis (IM) of esophageal squamous cell carcinoma (ESCC) is sometimes found with an incidence rate of 5.5-16.6%, and the prognosis of these patients was suggested to be dismal [1][2][3][4][5][6][7]. In our previous study, pathological IM has shown to be an indicator of lymphatic invasion and advanced cancer in ESCC patients [7].…”