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Journal of Gastroenterology

, Volume 52, Issue 7, pp 800–808 | Cite as

Risk of metastasis in adenocarcinoma of the esophagus: a multicenter retrospective study in a Japanese population

  • Ryu Ishihara
  • Tsuneo Oyama
  • Seiichiro Abe
  • Hiroaki Takahashi
  • Hiroyuki Ono
  • Junko Fujisaki
  • Mitsuru Kaise
  • Kenichi Goda
  • Kenro Kawada
  • Tomoyuki Koike
  • Manabu Takeuchi
  • Rie Matsuda
  • Dai Hirasawa
  • Masayoshi Yamada
  • Junichi Kodaira
  • Masaki Tanaka
  • Masami Omae
  • Akira Matsui
  • Takashi Kanesaka
  • Akiko Takahashi
  • Shinichi Hirooka
  • Masahiro Saito
  • Yosuke Tsuji
  • Yuki Maeda
  • Hiroharu Yamashita
  • Ichiro Oda
  • Yasuhiko Tomita
  • Takashi Matsunaga
  • Shuji Terai
  • Soji Ozawa
  • Tatsuyuki Kawano
  • Yasuyuki Seto
Original Article—Alimentary Tract

Abstract

Background

Little is known about the specific risks of metastasis in esophageal adenocarcinoma in relation to invasion depth or other pathologic factors.

Methods

We conducted a multicenter retrospective study in 13 high-volume centers in Japan from January 2000 to October 2014 to elucidate the risk of metastasis of esophageal adenocarcinoma. A total of 458 patients (217 surgically resected and 241 endoscopically resected) with esophageal adenocarcinoma or esophagogastric adenocarcinoma involving the esophagus were included. Metastasis was considered positive if there was histologically confirmed metastasis in the surgical specimen or clinically confirmed metastasis during follow-up. Metastasis was considered negative if no metastasis was identified in resected specimens and during follow-up in patients treated surgically or no metastasis during follow-up for >5 years in patients treated by endoscopic resection.

Results

Metastasis was identified in 72 patients. Multivariate analysis confirmed lymphovascular involvement [odds ratio (OR) 6.20; 95 % confidence interval (CI) 3.12–12.32; p < 0.001], a poorly differentiated component (OR 3.69; 95 % CI 1.92–7.10; p < 0.001), and lesion size >30 mm (OR 3.12; 95 % CI 1.63–5.97; p = 0.001) as independent risk factors for metastasis. No metastasis was detected in patients with mucosal cancer without lymphovascular involvement and a poorly differentiated component (0/186 lesions) or in patients with cancer invading the submucosa (1–500 µm) without lymphovascular involvement, a poorly differentiated component, and ≤30 mm (0/32 lesions).

Conclusions

Mucosal and submucosal cancers (1–500 µm invasion) without risk factors have a low incidence of metastasis and may thus be good candidates for endoscopic resection.

Keywords

Esophageal cancer Barrett’s esophagus Esophagogastric cancer Metastasis Endoscopic resection 

Notes

Acknowledgments

We thank Tomoki Shimizu, Yasutaka Kuribayashi, Yuko Hara, Hiroki Kikuchi, Yuichi Sato, Mitsuhiro Fujishiro, and Taku Yamagata for help with data collection, Yasuo Ohkura, Tomio Arai and Atsusi Ochiai for help with pathologic examination, and Junya Oguma, Takayuki Nishi for general advice.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Saku Central Hospital Ethics Committee.

Funding

Supported by a grant from the Japanese Gastroenterological Association.

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Copyright information

© Japanese Society of Gastroenterology 2016

Authors and Affiliations

  • Ryu Ishihara
    • 1
  • Tsuneo Oyama
    • 2
  • Seiichiro Abe
    • 3
  • Hiroaki Takahashi
    • 4
  • Hiroyuki Ono
    • 5
  • Junko Fujisaki
    • 6
  • Mitsuru Kaise
    • 7
  • Kenichi Goda
    • 8
  • Kenro Kawada
    • 9
  • Tomoyuki Koike
    • 10
  • Manabu Takeuchi
    • 11
  • Rie Matsuda
    • 12
  • Dai Hirasawa
    • 13
  • Masayoshi Yamada
    • 3
  • Junichi Kodaira
    • 4
  • Masaki Tanaka
    • 5
  • Masami Omae
    • 6
  • Akira Matsui
    • 7
  • Takashi Kanesaka
    • 1
  • Akiko Takahashi
    • 2
  • Shinichi Hirooka
    • 14
  • Masahiro Saito
    • 10
  • Yosuke Tsuji
    • 12
  • Yuki Maeda
    • 13
  • Hiroharu Yamashita
    • 15
  • Ichiro Oda
    • 3
  • Yasuhiko Tomita
    • 16
  • Takashi Matsunaga
    • 17
  • Shuji Terai
    • 11
  • Soji Ozawa
    • 18
  • Tatsuyuki Kawano
    • 9
  • Yasuyuki Seto
    • 15
  1. 1.Department of Gastrointestinal OncologyOsaka Medical Center for Cancer and Cardiovascular DiseasesOsakaJapan
  2. 2.Department of EndoscopySaku Central Hospital Advanced Care CenterSakuJapan
  3. 3.Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
  4. 4.Department of GastroenterologyKeiyukai Daini HospitalSapporoJapan
  5. 5.Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
  6. 6.Department of GastroenterologyCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
  7. 7.Department of GastroenterologyToranomon HospitalTokyoJapan
  8. 8.Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
  9. 9.Department of Esophageal and General SurgeryTokyo Medical and Dental UniversityTokyoJapan
  10. 10.Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan
  11. 11.Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
  12. 12.Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan
  13. 13.Department of GastroenterologySendai City Medical CenterSendaiJapan
  14. 14.Department of PathologyThe Jikei University School of MedicineTokyoJapan
  15. 15.Department of Gastrointestinal SurgeryThe University of Tokyo HospitalTokyoJapan
  16. 16.Department of PathologyOsaka Medical Center for Cancer and Cardiovascular DiseasesOsakaJapan
  17. 17.Department of Medical InformaticsOsaka Medical Center for Cancer and Cardiovascular DiseasesOsakaJapan
  18. 18.Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan

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