Risk stratification for early esophageal adenocarcinoma: Analysis of lymphatic spread

Barbour, Andrew P., Jones, Mark, Brown, Ian, Gotley, David C., Martin, Ian, Thomas, Janine, Clouston, Andre and Smithers, B. Mark (2010) Risk stratification for early esophageal adenocarcinoma: Analysis of lymphatic spread. Annals of Surgical Oncology, 17 9: 2494-2502. doi:10.1245/s10434-010-1025-0

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Author Barbour, Andrew P.
Jones, Mark
Brown, Ian
Gotley, David C.
Martin, Ian
Thomas, Janine
Clouston, Andre
Smithers, B. Mark
Title Risk stratification for early esophageal adenocarcinoma: Analysis of lymphatic spread
Journal name Annals of Surgical Oncology   Check publisher's open access policy
ISSN 1068-9265
1534-4681
Publication date 2010-09
Sub-type Article (original research)
DOI 10.1245/s10434-010-1025-0
Volume 17
Issue 9
Start page 2494
End page 2502
Total pages 9
Place of publication Hagerstown, MD, United States
Publisher Springer
Collection year 2011
Language eng
Formatted abstract
Background: Knowledge of factors related to outcome is vital for the selection of therapeutic alternatives for patients with early (T1) esophageal adenocarcinoma. This study was undertaken to determine predictors of lymphatic spread and prognostic factors for T1 esophageal adenocarcinoma following esophagectomy. Materials and Methods: A prospectively maintained database identified 85 patients with T1 esophageal adenocarcinoma who underwent esophagectomy without neoadjuvant therapy. Depth of tumor invasion (T stage) was subdivided into mucosal (T1a) or submucosal invasion (T1b). Median follow-up was 59 months.
Results:
Thoracoscopically assisted 3-phase esophagectomy was performed in 73 of 85 patients (86%). Lymph node metastases (N stage) were identified in 9 of 85 patients (11%). Depth of tumor invasion (T stage), lymphovascular invasion (LVI), and poor differentiation were associated with N stage. The patients could be stratified into 4 risk groups for lymph node metastases: group I-T1a (0 of 35 patients [0%] with positive nodes); group II-T1b, well/moderate differentiation and no LVI (1 of 28 patients [4%] with positive nodes); group III-T1b, poor differentiation and no LVI (2 of 9 patients [22%] with positive nodes); and group IV-T1b any grade with LVI (6 of 13 patients [46%] with positive nodes). Survival analyses found T stage, N stage, LVI, and poor differentiation to be significant prognostic factors.
Conclusions:
Risk stratification is possible for patents with T1 esophageal adenocarcinoma. Local resection techniques without lymphadenectomy may be alternatives for T1a tumors. Esophagectomy should remain the standard of care for patients with T1b tumors and those with LVI or poor differentiation considered for neoadjuvant therapy. © 2010 Society of Surgical Oncology.
Keyword High-grade dysplasia
Endoscopic mucosal resection
Long-term survival
Barretts-esophagus
Node metastasis
Photodynamic therapy
Muscularis mucosae
Squamous-cell
Gastroesophageal junction
Intraepithelial neoplasia
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Thu, 17 Mar 2011, 15:46:23 EST by Mrs Maureen Pollard on behalf of School of Medicine