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Infiltration Depth is the Most Relevant Risk Factor for Overall Metastases in Early Esophageal Adenocarcinoma

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Abstract

Background

Research in early esophageal adenocarcinoma focused on prediction of lymph node metastases in order to stratify patients for endoscopic treatment instead of esophagectomy. Although distant metastases were described in rates of up to 13% of patients within a follow-up of 3 years, their prediction has been neglected so far.

Methods

In a secondary analysis, a cohort of 217 patients (53 T1a and 164 T1b) treated by esophagectomy was analyzed for histopathological risk factors. Their ability to predict the combination of lymph node metastases at surgery as well as metachronous locoregional and distant metastases (overall metastatic rate) was assessed by uni- and multivariate logistic regression analysis.

Results

Tumor invasion depth was correlated with both lymph node metastases at surgery (τ = 0.141; P = .012), tumor recurrences (τ = 0.152; P = .014), and distant metastases (τ = 0.122; P = 0.04). Multivariate analysis showed an odds ratio of 1.31 (95% CI 1.02–1.67; P = .033) per increasing tumor invasion depth and of 3.5 (95% CI 1.70–6.56; P < .001) for lymphovascular invasion. The pre-planned subgroup analysis in T1b tumors demonstrated an even lower predictive ability of lymphovascular invasion with an odds ratio of 2.5 (95% CI 1.11–5.65; P = 0.028), whereas the predictive effect of sm2 (odds ratio 3.44; 95% CI 1.00–11.9; P = 0.049) and sm3 (odds ratio 3.44; 95% CI 1.00–11.9; P = 0.049) tumor invasion depth was similar.

Conclusions

The present report demonstrates the insufficient risk prediction of histopathologic risk factors for the overall metastatic rate.

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Acknowledgements

The authors thank Alexander Traut, Klinikum Essen-Mitte, Essen, Germany, for his assistance in statistical analysis.

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Authors and Affiliations

  1. Department of Paediatric Surgery, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Germany

    Christina Oetzmann von Sochaczewski

  2. Department of Surgery I, Sana Klinikum Offenbach, Offenbach, Germany

    Thomas Haist, Michael Pauthner & Markus Mann

  3. Institute of Pathology, Sana Klinikum Offenbach, Offenbach, Germany

    Susanne Braun

  4. Department of Internal Medicine II, Sana Klinikum Offenbach, Offenbach, Germany

    Christian Ell

  5. Department of Surgery I, Klinikum Darmstadt, Grafenstraße 9, 64283, Darmstadt, Germany

    Dietmar Lorenz

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  1. Christina Oetzmann von Sochaczewski
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Correspondence to Dietmar Lorenz.

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The present research was approved by the Medical Council of the State of Hessen (permit no. 48 of 99).

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The basis for the present study was laid during the mutual time in a joint working group at the Dr.-Horst-Schmidt-Kliniken, a tertiary referral hospital for upper GI-tumors of the city of Wiesbaden.

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Oetzmann von Sochaczewski, C., Haist, T., Pauthner, M. et al. Infiltration Depth is the Most Relevant Risk Factor for Overall Metastases in Early Esophageal Adenocarcinoma. World J Surg 44, 1192–1199 (2020). https://doi.org/10.1007/s00268-019-05291-6

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