Annals of Surgical Oncology

, Volume 17, Issue 9, pp 2494–2502 | Cite as

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

  • Andrew P. Barbour
  • Mark Jones
  • Ian Brown
  • David C. Gotley
  • Ian Martin
  • Janine Thomas
  • Andrew Clouston
  • B. Mark Smithers
Thoracic Oncology

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.

Keywords

Overall Survival Endoscopic Mucosal Resection Esophageal Adenocarcinoma Poor Differentiation Submucosal Invasion 

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Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Andrew P. Barbour
    • 1
  • Mark Jones
    • 2
  • Ian Brown
    • 3
  • David C. Gotley
    • 1
  • Ian Martin
    • 4
  • Janine Thomas
    • 4
  • Andrew Clouston
    • 5
  • B. Mark Smithers
    • 1
  1. 1.Division of SurgeryUniversity of QueenslandBrisbaneAustralia
  2. 2.Department of BiostatisticsPrincess Alexandra HospitalBrisbaneAustralia
  3. 3.Department of PathologyRoyal Brisbane HospitalBrisbaneAustralia
  4. 4.Department of SurgeryPrincess Alexandra HospitalBrisbaneAustralia
  5. 5.Department of PathologyPrincess Alexandra HospitalBrisbaneAustralia

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