World Journal of Surgery

, Volume 18, Issue 3, pp 321–330

Esophageal squamous cell carcinoma: Pathology and prognosis

  • Hiroko Ide
  • Tsutomu Nakamura
  • Kazuhiko Hayashi
  • Takeshi Endo
  • Ataru Kobayashi
  • Reiki Eguchi
  • Fujio Hanyu
Article

Abstract

Between 1985 and 1992 a total of 403 patients with resected thoracic esophageal squamous cell carcinoma were evaluated histopathologically, and various pathologic findings related to survival were examined. Concerning depth of tumor invasion, 8 (2%) cases were pTis, 110 (27%) were pT1, 48 (12%) were pT2, 202 (50%) were pT3, and 35 (9%) were pT4. Lymphatic invasion was detected in 299 cases (74%), blood vessel invasion in 200 cases (49%), intramural metastasis in 45 (11%), and lymph node metastasis in 232 (58%). In pT1 carcinoma cases, 4% of mucosal carcinomas and 30% of submucosal carcinomas had lymph node metastasis. Tumors with deeper invasion had a higher incidence of lymph node metastasis: 74% of pT3 carcinomas and 83% of pT4 carcinomas. The sites of lymph node metastasis were divided into mediastinal, cervical, and abdominal fields; and rates of lymph node metastasis were 49%, 14%, and 41%, respectively. In all resected cases, the operative mortality rate was 3.2%, and the overall 5-year survival rate was 44.8%. The 5-year survival rate of patients with curative resection (R0 and R1) was 49.5%, whereas patients with palliative resection (R2) did not survive more than 3 years. There was no significant difference in survival relative to tumor location. In curatively resected cases, the significant prognostic factors by multivariate analysis were pT category, vascular invasion, lymph node metastasis, and intramural metastasis. Prognosis of lymph node-positive cases did not depend on the positive node site. Patients with only one positive node had a better prognosis, and those with six or more positive nodes had a poor prognosis. Concerning lymph node metastasis, other factors that worsened prognosis were a positive node larger than 1 cm, two- to three-field metastasis, and positive cervical nodes in cases of lower-third esophageal carcinoma.

Résumé

Entre 1985 et 1992, 403 patients ayant eu une résection de leur cancer épidermoïde de l'oesophage thoracique ont eu une évaluation histopathologique corrélée avec la survie. En ce qui concerne la profondeur de l'invasion, huit cas (2%) étaient des pTis, 110 (38%) étaient des pT1, 48 (12%) étaient des pT2, 202 (50%) étaient des pT3, et 35 (8%) étaient des pT4. L'atteinte lymphatique a été détectée chez 299 (74%) patients, une invasion vasculaire dans 200 (49%) des cas, une résurgence intramurale dans 45 (11%) des cas et une atteìnte ganglionnaire chez 232 (58%) des cas. Dans le cas des tumeurs pT1, 4% des cancers de la muqueuse, et 30% des cancers de la sous-muqueuse étaient accompagnées de métastases ganglionnaires. Des tumeurs ayant une invasion plus profonde, les pT3 et les pT4 étaient associées à des métastases ganglionnaires dans 74% et 83% des cas. Les sites des métastases ganglionnaires étaient le médiastin, les chaînes cervicales, et l'abdomen chez, respectivement, 49%, 14% et 41% des cas. Parmi les cas de résection, la mortalité opératoire était de 3.2% et la survie globale à 5 ans étaient de 44.8%. La survie à 5 ans des patients ayant eu une résection à visée curative (R0 et R1) était de 49.5% alors qu'aucun des patients ayant eu une résection palliative (R2) n'étaient en vie à 3 ans. Il n'y avait aucune différence de survie selon la localisation tumorale. Chez les patients réséqués de façon curative, les facteurs pronostiques significatifs étaient la classe pT, l'invasion vasculaire, la métastase lymphatique, et l'invasion intramurale. Le pronostic des patients ayant une métastase ganglionnaire était indépendant de la localisation. Le pronostic des patients ayant un seul ganglion envahi était meilleur que le pronostic des patients ayant six ou plus de ganglions envahis. Le pronostic était moins bon lorsque la métastase ganglionnaire était plus grande que 1 cm, intéressait plus de 2–3 champs différents et lorsqu'elle intéressait la chaîne cervicale en cas de cancer du tiers inférieur de l'oesophage.

Resumen

Se analizaron desde el punto de vista histopatológico 403 pacientes, 348 hombres y 55 mujeres, sometidos a resección de carcinoma escamocelular del esófago torácico en el período 1985 a 1992, y se examinaron diversos hallazgos patológicos en relación a sobrevida. En cuanto a profundidad de invasión tumoral, 8(2%) casos fueron Tis, 110(38%) p T1, 48(12%) p T2, 202(50%) p T3 y 35(8%) p T4. Se detectó invasión linfática en 299 casos (74%), invasión de vasos sanguíneos en 200 (49%), metástasis intramurales en 45(11%) y metástasis ganglionares en 232 (58%). Entre los casos en estado p T1, 4% de los carcinomas mucosos y 30% de los submucosos tenían metástasis ganglionares.

Los tumores con invasión más profunda exhibieron una mayor incidencia de metástasis ganglionares, 74% en los pacientes en estado pT3 y 83% en los estados pT4. La ubicación de las metástasis ganglionares fue dividida en tres campos: mediastinal, cervical y abdominal, y las ratas de metástasis ganglionares correspondientes fueron 49%, 14%, y 41%. La tasa de mortalidad operatoria fue 3.2% y la tasa global de sobrevida a 5 años fue 44.8%; para los casos con resección curativa (R0 y R1) ésta fue de 49.5%, en tanto que ninguno de los pacientes con resección paliative (R2) sobrevivió más allá de 3 años no se hallaron diferencias significativas en lo relativo a ubicación del cáncer.

En los pacientes con resección curativa, los factores pronóstico de importancia significativa determinados por análisis multivariado fueron el estado pT, la invasión vascular, las metástasis ganglionares y las metástasis intramurales. El pronóstico en los pacientes con ganglios positivos no dependió de la ubicación de los ganglios afectados, y los pacientes con sólo un ganglio afectado tuvieron un mejor pronóstico, en tanto que aquellos con 6 o más ganglios afectados tuvieron un pronóstico pobre.

En lo relativo a las metástasis ganglionares, otros factores que ensombrecieron el pronóstico fueron los ganglios mayores de 1 cm, metástasis a 2–3 campos y ganglios cervicales positivos cuando el carcinoma primario era del tercio inferior del esófago.

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Copyright information

© Société Internationale de Chirurgie 1994

Authors and Affiliations

  • Hiroko Ide
    • 1
  • Tsutomu Nakamura
    • 1
  • Kazuhiko Hayashi
    • 1
  • Takeshi Endo
    • 1
  • Ataru Kobayashi
    • 1
  • Reiki Eguchi
    • 1
  • Fujio Hanyu
    • 1
  1. 1.Department of Surgery, Institute of GastroenterologyTokyo Women's Medical CollegeJapan

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